title: Chronotropic incompetence and autonomic dysfunction in patients without structural heart disease.
abstract: OBJECTIVE
  An attenuated heart rate response to exercise, termed chronotropic incompetence (CI), has been reported to be an independent predictor of cardiovascular mortality. We examined the change in autonomic function during exercise testing and correlated the results with CI.
  
  
  RESULTS
  Exercise testing using a bicycle ergometer was performed in 172 patients who had no evidence of cardiac disease. Chronotropic incompetence was defined as the failure to achieve 85% of the age-predicted maximum heart rate, heart rate reserve <80%, or chronotropic response index <0.80. We analysed the relationship between CI and the change in two components of heart rate variability during exercise testing: high-frequency (HF) component (0.15-0.40 Hz) as an index of vagal modulation and the ratio of low-frequency (LF) component (0.04-0.15 Hz) to HF component as an index of sympathovagal balance. Heart rate variability indexes before exercise were similar in patients with and without CI. Percentage changes after exercise in the ratio of LF to HF component were higher in patients with CI than in those without CI (84 +/- 15 vs. 41 +/- 16%, P < 0.05), whereas percentage changes in an HF component were similar in the two groups.
  
  
  CONCLUSIONS
  Our data suggested that CI in patients without structural heart disease was mainly caused by a pathophysiological condition in which sympathetic activation was not well translated into heart rate increase. Further study is needed to determine the post-synaptic sensitivity of the beta-adrenergic receptor pathway in relation to CI.
authors.affiliation: Department of Cardiology, Matsushita Memorial Hospital, Sotojima 5-55, Moriguchi, Osaka 570-8540, Japan. js-k@wf6.so-net.ne.jp
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kawasaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaimoto
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sakatani
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Miki
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Kamitani
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kuribayashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsubara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugihara
mesh_terms: D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000294:innervation / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014630:Vagus Nerve / Q000503:physiopathology