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Chronotropic incompetence and coronary artery disease

2010; Taylor & Francis; Volume: 65; Issue: 6 Linguagem: Inglês

10.1080/ac.65.6.2059859

1784-973X

Fernando D Anjos-Andrade, Antônio Carlos Sobral Sousa, José Augusto Soares Barreto-Filho, Érica O. Alves, Adão C. Nascimento-Junior, Nathalie Oliveira de Santana, Francis Lima De Vasconcelos, Flávia Barreto Garcez, Vanessa P. Araújo, Ana Carla Pereira de Araújo, Bruno Fernandes de Oliveira Santos, Débora Consuelo Rocha Silveira, Rívia Siqueira Amorim, Diego Leonardo Cruz Lima Garcia, José Carlos Sizino Franco Filho, Antônio Aristides De Sá Neto, Flávia Ricci Calasans, Enaldo Vieira de Melo, Joselina Luzia Menezes Oliveira,

Cardiovascular Function and Risk Factors

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 years; 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.