Chronotropic Incompetence Limits Aerobic Exercise Capacity in Patients Taking Beta-Blockers: Real-Life Observation of Consecutive Patients

Background: Chronotropic incompetence in patients taking beta-blockers is associated with poor prognosis; however, its impact on exercise capacity (EC) remains unclear. Methods: We analyzed data from consecutive patients taking beta-blockers referred for cardiopulmonary exercise testing to assess EC. Chronotropic incompetence was defined as chronotropic index (CI) <= 62%. Results: Among 140 patients all taking beta-blockers (age 61 +/- 9.7 years; 73% males), 64% with heart failure, chronotropic incompetence was present in 80.7%. EC assessed as peak oxygen uptake was lower in the group with chronotropic incompetence, 18.3 +/- 5.7 vs. 24.0 +/- 5.3 mL/kg/min, p < 0.001. EC correlated positively with CI (beta = 0.14, p < 0.001) and male gender (beta = 5.12, p < 0.001), and negatively with age (beta = -0.17, p < 0.001) and presence of heart failure (beta = -3.35, p < 0.001). Beta-blocker dose was not associated with EC. Partial correlation attributable to CI accounted for more than one-third of the variance in EC explained by the model (adjusted R-2 = 59.8%). Conclusions: In patients taking beta-blockers, presence of chronotropic incompetence was associated with lower EC, regardless of the beta-blocker dose. CI accounted for more than one-third of EC variance explained by our model.

Automated summary

This study found that in patients taking beta-blockers, a high prevalence of chronotropic incompetence was associated with lower exercise capacity. Chronotropic incompetence accounted for more than one-third of the variance in exercise capacity explained by the model.