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Document Details : Title: Chronotropic incompetence and coronary artery disease Author(s): F.D. Anjos-Andrade , A.C. Sobral Sousa , J.A.S. Barreto-Filho , É. Oliveira Alves , A.C. Nascimento-Júnior , N. Oliveira de Santana , F. Lima de Vasconcelos , F. Barreto Garcez , V. Porto de Araujo , A.C. Pereira de Araujo , B. Fernandes de Oliveira Santos , R. Silveira , R. Siqueira Amorim , D.L. Cruz Lima Garcia , J.C. Sizino Franco Filho , A. Aristides de sá Neto , F. Ricci Calasans , E. Vieira de Melo , J.L. Menezes Oliveira Journal: Acta Cardiologica Volume: 65 Issue: 6 Date: 2010 Pages: 631-638 DOI: 10.2143/AC.65.6.2059859 Abstract : Objective — Although chronotropic incompetence (CI) represents an independent predictor of mortality and incidence of coronary artery disease, its pathophysiological mechanisms remain unknown. The purpose of this investigation was to evaluate wall motion abnormalities of the left ventricle and location of coronary arterial lesions in patients with and without CI. Methods — After exclusion of confounding factors, 610 patients (mean age of 58.4 ± 11 ears; 275 men) with ischaemia who underwent exercise echocardiography were studied. Based on heart rate (HR) reached in treadmill testing, patients were divided into two groups: ChI (97 patients who did not reach 85% of maximum HR recommended for age) and ChC (513 patients who achieved 85% of the maximum age-predicted HR). Results — There was a higher frequency of dyspnoea (5.2% vs. 0.6%, P = 0.003), systemic hypertension (69.1% vs. 57.3%, P = 0.031) and obesity (38.1% vs. 22.6%, P = 0.001), and a lower tolerance to effort (dyspnoea as limitation of physical effort: 36.1% vs. 8.0%, P < 0.0001; duration of treadmill test: 4.4 ± 2.2 vs. 7.2 ± 2.8, P < 0.0001; METs: 6.0 ± 2.6 vs. 8.4 ± 2.9, P = 0.002) in ChI compared to ChC. The wall motion score index (WMSI) was higher in ChI than in ChC, both at rest (1.15 ± 0.29 vs. 1.07 ± 0.19, P = 0.011) and after exercise (1.24 ± 0.29 vs. 1.15 ± 0.19, P = 0.002). Systolic function, which was evaluated in peak exercise through WMSI, was significantly more altered in the ChI group. The presence of severe injuries in right coronary was independently associated with CI (adjusted OR = 3.57, CI 95%: 1.86-6.87). Conclusion — Chronotropic incompetence is associated with ventricular dysfunction in peak exercise and critical right coronary artery lesions. |
