Association of Chronic Kidney Disease With Chronotropic Incompetence in Heart Failure With Preserved Ejection Fraction

Klein, David A.;
Katz, Daniel H.; Beussink-Nelson, Lauren; Sanchez, Cynthia L.;
Strzelczyk, Theresa A.; Shah, Sanjiv J..

The American Journal of Cardiology, October 2015, Vol. 116 Issue: Number 7 p1093-1100, 8p

Abstract: Chronotropic incompetence (CI) is common in heart failure
with preserved ejection fraction (HFpEF) and may be a key reason
underlying exercise intolerance in these patients. However, the
determinants of CI in HFpEF are unknown. We prospectively studied 157
patients with consecutive HFpEF who underwent cardiopulmonary exercise
testing and defined CI according to specific thresholds of the percent
heart rate reserve (%HRR). CI was diagnosed as present if %HRR <80 if
not taking a β blocker and <62 if taking β blockers. Participants who
achieved inadequate exercise effort (respiratory exchange ratio ≤1.05)
on cardiopulmonary exercise testing were excluded.
Multivariable-adjusted logistic regression was used to determine the
factors associated with CI. Of the 157 participants, 108 (69%) achieved
a respiratory exchange ratio >1.05 and were included in the final
analysis. Of these 108 participants, 70% were women, 62% were taking β
blockers, and 38% had chronic kidney disease. Most patients with HFpEF
met criteria for CI (81 of 108; 75%). Lower estimated glomerular
filtration rate (GFR), higher B-type natriuretic peptide, and higher
pulmonary artery systolic pressure were each associated with CI. A 1-SD
decrease in GFR was independently associated with CI after
multivariable adjustment (adjusted odds ratio 2.2, 95% confidence
interval 1.1 to 4.4, p = 0.02). The association between reduced GFR and
CI persisted when considering a variety of measures of chronotropic
response. In conclusion, reduced GFR is the major clinical correlate of
CI in patients with HFpEF, and further study of the relation between
chronic kidney disease and CI may provide insight into the
pathophysiology of CI in HFpEF.