Evaluation of Cardiometabolic Factors Affecting Chronotropic Incompetence: A Cross-Sectional Retrospective Study in Sanglah General Hospital, Bali
A Cross-Sectional Retrospective Study in Sanglah General Hospital, Bali
Background: Recent studies have identified that chronotropic incompetence is correlated with poor cardiometabolic health and systemic inflammation that results in exercise intolerance, impaired quality of life and death due to cardiovascular disease (CVD). Unfortunately, there’s still paucity of data regarding cardiometabolic factors associated with chronotropic incompetence. The purpose of this study was to identify the cardiometabolic factors associated with chronotropic incompetence.
Methods: This study was a cross-sectional retrospective study using cardiac treadmill stress test data at Sanglah General Hospital from May 2018 - May 2020 and 136 patients were enrolled. Data analysis used SPSS version 21. Pearson chi-square test was used to compare categorical variables based on cardiometabolic risk factors in chronotropic incompetence.
Results: Patients were divided based on the characteristics of age, gender, smoking status, body mass index, coronary artery disease, heart failure, hypertension, dyslipidemia, type 2 diabetes mellitus (T2DM), the levels of HbA1C, total cholesterol, LDL, HDL, and triglyceride. In this study, it was found that T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), high total cholesterol (PR 2.396; 95%CI 1.650-3;481), and high LDL level (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value <0.05), while other factors were not significantly related.
Conclusion: Chronotropic incompetence can impair quality of life and contribute to cardiovascular mortality. However, T2DM, high HbA1C, dyslipidemia, high total cholesterol and LDL levels were found to be associated with chronotropic incompetence. This may contribute to higher cardiovascular risk attributed to those factors.
2. Laforgia P, Bandera F, Alfonzetti E, Guazzi M. Exercise chronotropic incompetence phenotypes the level of cardiovascular risk and exercise gas exchange impairment in the general population. An analysis of the Euro-EX prevention trial. European Journal of Preventive Cardiology. 2019;27(5):526-535. Available from: https://academic.oup.com/eurjpc/article/27/5/526/5924894?login=true
3. Herbsleb M, Keller-Varady K, Wobrock T, Hasan A, Schmitt A, Falkai P et al. The Influence of Continuous Exercising on Chronotropic Incompetence in Multi-Episode Schizophrenia. Frontiers in Psychiatry. 2019;10(90):1-7. Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00090/full
4. Zweerink A, van der Lingen A, Handoko M, van Rossum A, Allaart C. Chronotropic Incompetence in Chronic Heart Failure. Circulation: Heart Failure. 2018;11(8):1-12. Available from: https://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.118.004969
5. Zafrir B. The prognostic value of exercise testing: Exercise capacity, hemodynamic response, and cardio-metabolic risk factors. European Journal of Preventive Cardiology. 2017;24(15):1624-1626. Available from: https://journals.sagepub.com/doi/full/10.1177/2047487317727337
6. Hansen D, Dendale P. Modifiable predictors of chronotropic incompetence in male patients with type 2 diabetes. J Cardiopulm Rehabil Prev 2014;34:202–7.
7. GondoniLA,TitonAM,NibbioF,AugelloG,CaetaniG,LiuzziA.Heartratebehavior during an exercise stress test in obese patients. Nutr Metab Cardiovasc Dis 2009;19:170-6.
8. Chronotropic Incompetence: What Is a Modifiable Risk Factor?. Acta Cardiologia Indonesian. 2021;3(1).
9. Brubaker P, Kitzman D. Chronotropic Incompetence. Circulation. 2011;123(9):1010-1020.
10. Lauer M, Okin P, Larson M, Evans J, Levy D. Impaired Heart Rate Response to Graded Exercise. Circulation. 1996;93(8):1520-1526.
11. Tsuji H, Venditti FJ, Manders ES, Evans JC, Larson MG, Feldman CL, Levy D. Reduced heart rate variability and mortality risk in an elderly cohort: the Framingham Heart Study. Circulation.1994; 90:878-883.
12. Keytsman C, Dendale P, Hansen D. Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy. Sports Medicine. 2015;45(7):985-995.
13. Franssen W, Keytsman C, Marinus N, Verboven K, Eijnde B, van Ryckeghem L et al. Chronotropic incompetence is more frequent in obese adolescents and relates to systemic inflammation and exercise intolerance. Journal of Sport and Health Science. 2021;.
14. Lambert E, Straznicky N, Sari CI, et al. Dyslipidemia is associated with sympathetic nervous activation and impaired endothelial function in young females. Am J Hypertens 2013;26:250–6.
15. Jae S, Fernhall B, Heffernan K, Kang M, Lee M, Choi Y et al. Chronotropic response to exercise testing is associated with carotid atherosclerosis in healthy middle-aged men. European Heart Journal. 2006;27(8):954-959.
16. Jang E, Park Y, Hur J, Kim M, Ko S, Baek K et al. Higher levels of small dense low-density lipoprotein (LDL) are associated with cardiac autonomic neuropathy in patients with Type 2 diabetes. Diabetic Medicine. 2013;30(6):694-701.
17. Salvadori A, Fanari P, Giacomotti E, et al. Kinetics of catecholamines and potassium, and heart rate during exercise testing in obese subjects. Heart rate regulation in obesity during exercise. Eur J Nutr 2003;42:181–7.
18. Del Rio G. Adrenomedullary function and its regulation in obesity. Int J Obes Relat Metab Disord 2000;24(Suppl. 2):S89–91.
19. Mannelli M, Lanzillotti R, Pupilli C, Ianni L, Conti A, Serio M. Adrenal medulla secretion in Cushing’s syndrome. J Clin Endocrinol Metab 1994;78:1331–5.
20. Salvadori A, Fanari P, Giacomotti E, et al. Kinetics of catecholamines and potassium, and heart rate during exercise testing in obese subjects. Heart rate regulation in obesity during exercise. Eur J Nutr 2003;42:181–7.
21. Jellis CL, Stanton T, Leano R, et al. Usefulness of at rest and exercise hemodynamics to detect subclinical myocardial dis- ease in type 2 diabetes mellitus. Am J Cardiol. 2011;107(4): 615–21.
22. Hansen D, Dendale P. Modifiable predictors of chronotropic in- competence in male patients with type 2 diabetes. J Cardiopulm Rehabil Prev. 2014;34(3):202–7.
23. Hansen D, Dendale P. Modifiable predictors of chronotropic incompetence in male patients with type 2 diabetes. J Cardiopulm Rehabil Prev. 2014 May-Jun;34(3):202-7. doi: 10.1097/HCR.0000000000000039. PMID: 24481127.
24. Dhumad M, Hamdan F, Khudhair M, Al-Matubsi H. Correlation of staging and risk factors with cardiovascular autonomic neuropathy in patients with type II diabetes mellitus. Scientific Reports. 2021;11(1).
25. Bhuyan, A. K., Baro, A., Sarma, D. & Choudhury, B. A study of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus: a Northeast India experience. Indian J. Endocrinol. Metab. 23(2), 246. https://doi.org/10.4103/ijem.IJEM_336_18 (2019).
26. Ahire, C., Sarode, V., Jadhav, K., Shreeram, V. & Gaidhani, N. Prevalence of cardiac autonomic neuropathy in short and long- standing type 2 diabetics in western Maharashtra. Indian J. Basic Appl. Med. Res. 3(4), 252–259 (2014).
27. Hirsh BJ, Mignatti A, Garan AR, et al. Effect of beta-blocker cessation on chronotropic incompetence and exercise tolerance in patients with advanced heart failure. Circ Heart Fail. 2012;5(5):560–5.
28. Colucci WS, Ribeiro JP, Rocco MB, et al. Impaired chronotropic response to exercise in patients with congestive heart failure: role of postsynaptic beta-adrenergic desensitization. Circulation. 1989;80(2):314–23.
29. Witte KK, Cleland JG, Clark AL. Chronic heart failure, chronotropic incompetence, and the effects of beta blockade. Heart. 2006;92(4):481–6.
30. Clark AL, Coats AJ. Chronotropic incompetence in chronic heart failure. Int J Cardiol. 1995;49(3):225–31.
31. Kawasaki T, Kaimoto S, Sakatani T, et al. Chronotropic incom- petence and autonomic dysfunction in patients without structural heart disease. Europace. 2010;12(4):561–6.
32. Khan M, Pothier C, Lauer M. Chronotropic Incompetence as a Predictor of Death Among Patients With Normal Electrograms Taking Beta Blockers (Metoprolol or Atenolol). The American Journal of Cardiology. 2005;96(9):1328-1333.
33. Kiviniemi A, Tulppo M, Hautala A, Mäkikallio T, Perkiömäki J, Seppänen T et al. Long-term outcome of patients with chronotropic incompetence after an acute myocardial infarction. Annals of Medicine. 2010;43(1):33-39.
34. González-Costello J, Armstrong H, Jorde U, Bevelaqua A, Letarte L, Thomashow B et al. Chronotropic incompetence predicts mortality in severe obstructive pulmonary disease. Respiratory Physiology & Neurobiology. 2013;188(2):113-118
35. Ehara M, Shibata K, Kameshima M, Konaka M, Fujiyama H, Katoh M et al. Recovery from Chronotropic Incompetence during Phase II Cardiac Rehabilitation Contributes to the Better Future Cardiovascular Prognosis. Journal of Cardiac Failure. 2017;23(10):S59.
36. Liu, B. & Liu, X. & Wang, Y.. (2016). Effects of 12 weeks exercise-based rehabilitation on chronotropic response and heart rate recovery in patients with coronary heart disease. 31. 765-769. 10.3969/j.issn.1001-1242.2016.07.010.
Fulltext (PDF) downloads: 62
Copyright (c) 2022 Indonesian Journal of Cardiology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).