IRCCS SDN, Via Gianturco, 113, 80142, Naples, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Heart Fail Rev. 2018 Jul;23(4):537-545. doi: 10.1007/s10741-018-9712-1.
Exercise intolerance is a typical manifestation of patients affected by heart failure with reduced ejection fraction (HFrEF); however, the relationship among functional capacity, mortality, and exercise-induced heart rate response during exercise remains unclear in either sinus rhythm or atrial fibrillation subjects. Heart rate increase during incremental load exercise has a typical pattern in normal subjects, whereas it is commonly compromised in HFrEF patients, mainly due to the imbalance of the autonomic nervous system. In the present review, we aim to describe the behavior of heart rate during exercise in normal subjects and in HFrEF patients in sinus rhythm and atrial fibrillation, understanding and explaining the mechanism leading to a different exercise performance and functional limitation. Moreover, the role of chronotropic incompetence and the need of standardizing the cutoff criteria are also discussed in order to clarify the clinical importance, the prognostic relevance, and the potential therapeutic implications of this condition. Looking into the relative contribution and interaction of heart rate response during exercise might represent an important issue to guide individualized therapeutic interventions and prognostic assessment in HFrEF patients.
运动不耐受是射血分数降低的心力衰竭（HFrEF）患者的典型表现；然而，在窦性节律或心房颤动患者中，运动时的功能能力、死亡率和运动诱导的心率反应之间的关系尚不清楚。在正常受试者中，递增负荷运动期间的心率增加具有典型模式，而在 HFrEF 患者中，由于自主神经系统失衡，通常会受到损害。在本综述中，我们旨在描述窦性节律和心房颤动的正常受试者和 HFrEF 患者在运动时的心率行为，理解和解释导致不同运动表现和功能限制的机制。此外，还讨论了变时性不全的作用和标准化截止标准的必要性，以阐明这种情况的临床重要性、预后相关性和潜在的治疗意义。研究运动时的心率反应的相对贡献和相互作用可能是指导 HFrEF 患者个体化治疗干预和预后评估的一个重要问题。
