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Abnormal heart rate recovery and deficient chronotropic response after submaximal exercise in young Marfan syndrome patients

  • Paulo Peres (a1) (a2), Antônio C. Carvalho (a1), Ana Beatriz A. Perez (a3) (a4) and Wladimir M. Medeiros (a1) (a5)

Abstract

Background

Marfan syndrome patients present important cardiac structural changes, ventricular dysfunction, and electrocardiographic changes. An abnormal heart rate response during or after exercise is an independent predictor of mortality and autonomic dysfunction. The aim of the present study was to compare heart rate recovery and chronotropic response obtained by cardiac reserve in patients with Marfan syndrome subjected to submaximal exercise.

Methods

A total of 12 patients on β-blocker therapy and 13 off β-blocker therapy were compared with 12 healthy controls. They were subjected to submaximal exercise with lactate measurements. The heart rate recovery was obtained in the first minute of recovery and corrected for cardiac reserve and peak lactate concentration.

Results

Peak heart rate (141±16 versus 155±17 versus 174±8 bpm; p=0.001), heart rate reserve (58.7±9.4 versus 67.6±14.3 versus 82.6±4.8 bpm; p=0.001), heart rate recovery (22±6 versus 22±8 versus 34±9 bpm; p=0.001), and heart rate recovery/lactate (3±1 versus 3±1 versus 5±1 bpm/mmol/L; p=0.003) were different between Marfan groups and controls, respectively. All the patients with Marfan syndrome had heart rate recovery values below the mean observed in the control group. The absolute values of heart rate recovery were strongly correlated with the heart rate reserve (r=0.76; p=0.001).

Conclusion

Marfan syndrome patients have reduced heart rate recovery and chronotropic deficit after submaximal exercise, and the chronotropic deficit is a strong determinant of heart rate recovery. These changes are suggestive of autonomic dysfunction.

Copyright

Corresponding author

Correspondence to: W. M. Medeiros, Pneumology Department, Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Federal University of São Paulo, Rua Professor Francisco de Castro 54, Vila Clementino, São Paulo, CEP: 04050-020, Brasil. Tel: +55 11 5082 4420; Fax: 55 11 5082 4420; E-mail: wmusettimedeiros@hotmail.com

References

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1. Dean, JC. Management of Marfan syndrome. Heart 2002; 88: 97103.
2. Stheneur, C, Collod-Beroud, G, Faivre, L, et al. Identification of the minimal combination of clinical features in probands for efficient mutation detection in the FBN1 gene. Eur J Hum Genet 2009; 17: 11211128.
3. De Paepe, A, Devereux, RB, Dietz, HC, Hennekam, RC, Pyeritz, RE. Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet 1996; 62: 417426.
4. Braverman, AC. Exercise and the Marfan syndrome. Med Sci Sports Exerc 1998; 30: S387S395.
5. Medeiros, WM, Peres, PA, Carvalho, AC, Gun, C, De Luca, FA. Effect of a physical exercise program in a patient with Marfan syndrome and ventricular dysfunction. Arq Bras Cardiol 2012; 98: e70e73.
6. Savolainen, A, Kupari, M, Toivonen, L, Kaitila, I, Viitasalo, M. Abnormal ambulatory electrocardiographic findings in patients with the Marfan syndrome. J Intern Med 1997; 241: 221226.
7. Lawless, CE, Best, TM. Electrocardiograms in athletes: interpretation and diagnostic accuracy. Med Sci Sports Exerc 2008; 40: 787798.
8. Aydin, A, Adsay, BA, Sheikhzadeh, S, et al. Observational cohort study of ventricular arrhythmia in adults with Marfan syndrome caused by FBN1 mutations. PLoS One 2013; 8: e81281.
9. Savin, WM, Davidson, DM, Haskell, WL. Autonomic contribution to heart rate recovery from exercise in humans. J Appl Physiol 1982; 53: 15721575.
10. Shetler, K, Marcus, R, Froelicher, VF, et al. Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol 2001; 38: 19801987.
11. Cole, CR, Foody, JM, Blackstone, EH, Lauer, MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med 2000; 132: 552555.
12. Nishime, EO, Cole, CR, Blackstone, EH, Pashkow, FJ, Lauer, MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA 2000; 284: 13921398.
13. Nissinen, SI, Makikallio, TH, Seppanen, T, et al. Heart rate recovery after exercise as a predictor of mortality among survivors of acute myocardial infarction. Am J Cardiol 2003; 91: 711714.
14. Morshedi-Meibodi, A, Larson, MG, Levy, D, O’Donnell, CJ, Vasan, RS. Heart rate recovery after treadmill exercise testing and risk of cardiovascular disease events (The Framingham Heart Study). Am J Cardiol 2002; 90: 848852.
15. Cole, CR, Blackstone, EH, Pashkow, FJ, Snader, CE, Lauer, MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 1999; 341: 13511357.
16. Guazzi, M, Myers, J, Ann Peberdy, M, et al. Heart rate recovery and tissue Doppler echocardiography in heart failure. Clin Cardiol 2010; 33: E61E64.
17. Maeder, MT, Duerring, C, Engel, RP, et al. Predictors of impaired heart rate recovery: a myocardial perfusion SPECT study. Eur J Cardiovasc Prev Rehabil 2010; 17: 303308.
18. Negishi, K, Seicean, S, Negishi, T, Yingchoncharoen, T, Aljaroudi, W, Marwick, TH. Relation of heart-rate recovery to new onset heart failure and atrial fibrillation in patients with diabetes mellitus and preserved ejection fraction. Am J Cardiol 2013; 111: 748753.
19. Racine, N, Blanchet, M, Ducharme, A, et al. Decreased heart rate recovery after exercise in patients with congestive heart failure: effect of beta-blocker therapy. J Card Fail 2003; 9: 296302.
20. Tanaka, H, Monahan, KD, Seals, DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol 2001; 37: 153156.
21. Camarda, SR, Tebexreni, AS, Pafaro, CN, et al. Comparison of maximal heart rate using the prediction equations proposed by Karvonen and Tanaka. Arq Bras Cardiol 2008; 91: 311314.
22. Godoi, M. I National Consensus of Cardiovascular Rehabilitation. Arq Bras Cardiol 1997; 69: 267291.
23. Nunan, D, Donovan, G, Jakovljevic, DG, Hodges, LD, Sandercock, GR, Brodie, DA. Validity and reliability of short-term heart-rate variability from the Polar S810. Med Sci Sports Exerc 2009; 41: 243250.
24. Lauer, MS, Francis, GS, Okin, PM, Pashkow, FJ, Snader, CE, Marwick, TH. Impaired chronotropic response to exercise stress testing as a predictor of mortality. JAMA 1999; 281: 524529.
25. De Backer, JF, Devos, D, Segers, P, et al. Primary impairment of left ventricular function in Marfan syndrome. Int J Cardiol 2006; 112: 353358.
26. Nakamura, M, Itoh, S, Makita, S, Ohira, A, Arakawa, N, Hiramori, K. Peripheral resistance vessel dysfunction in Marfan syndrome. Am Heart J 2000; 139: 661666.
27. Percheron, G, Fayet, G, Ningler, T, et al. Muscle strength and body composition in adult women with Marfan syndrome. Rheumatology 2007; 46: 957962.
28. Giske, L, Stanghelle, JK, Rand-Hendrikssen, S, Strom, V, Wilhelmsen, JE, Roe, C. Pulmonary function, working capacity and strength in young adults with Marfan syndrome. J Rehabil Med 2003; 35: 221228.
29. Crilley, JG, Bendahan, D, Boehm, EA, et al. Investigation of muscle bioenergetics in the Marfan syndrome indicates reduced metabolic efficiency. J Cardiovasc Magn Reson 2007; 9: 709717.
30. Imai, K, Sato, H, Hori, M, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 1994; 24: 15291535.
31. Danieli, A, Lusa, L, Potocnik, N, Meglic, B, Grad, A, Bajrovic, FF. Resting heart rate variability and heart rate recovery after submaximal exercise. Clin Auton Res 2014; 24: 5361.
32. Barak, OF, Ovcin, ZB, Jakovljevic, DG, Lozanov-Crvenkovic, Z, Brodie, DA, Grujic, NG. Heart rate recovery after submaximal exercise in four different recovery protocols in male athletes and non-athletes. J Sports Sci Med 2011; 10: 369375.
33. Paton, JF, Boscan, P, Pickering, AE, Nalivaiko, E. The yin and yang of cardiac autonomic control: vago-sympathetic interactions revisited. Brain Res Rev 2005; 49: 555565.
34. 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: 314323.
35. Desai, MY, De la Pena-Almaguer, E, Mannting, F. Abnormal heart rate recovery after exercise as a reflection of an abnormal chronotropic response. Am J Cardiol 2001; 87: 11641169.
36. Walgenbach, SC, Shepherd, JT. Role of arterial and cardiopulmonary mechanoreceptors in the regulation of arterial pressure during rest and exercise in conscious dogs. Mayo Clin Proc 1984; 59: 467475.
37. Chen, S, Fagan, LF, Nouri, S, Donahoe, JL. Ventricular dysrhythmias in children with Marfan’s syndrome. Am J Dis Child 1985; 139: 273276.
38. Maslen, CL, Glanville, RW. The molecular basis of Marfan syndrome. DNA Cell Biol 1993; 12: 561572.
39. Behan, WM, Longman, C, Petty, RK, et al. Muscle fibrillin deficiency in Marfan’s syndrome myopathy. J Neurol Neurosurg Psychiatry 2003; 74: 633638.
40. Savolainen, A, Nisula, L, Keto, P, et al. Left ventricular function in children with the Marfan syndrome. Eur Heart J 1994; 15: 625630.
41. Piepoli, MF, Kaczmarek, A, Francis, DP, et al. Reduced peripheral skeletal muscle mass and abnormal reflex physiology in chronic heart failure. Circulation 2006; 114: 126134.
42. Gharacholou, SM, Scott, CG, Borlaug, BA, et al. Relationship between diastolic function and heart rate recovery after symptom-limited exercise. J Card Fail 2012; 18: 3440.
43. Cipriano, GF, Peres, PA, Cipriano, G Jr, Arena, R, Carvalho, AC. Safety and cardiovascular behavior during pulmonary function in patients with Marfan syndrome. Clin Genet 2010; 78: 5765.

Keywords

Abnormal heart rate recovery and deficient chronotropic response after submaximal exercise in young Marfan syndrome patients

  • Paulo Peres (a1) (a2), Antônio C. Carvalho (a1), Ana Beatriz A. Perez (a3) (a4) and Wladimir M. Medeiros (a1) (a5)

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