Effect of Carvedilol on Heart Rate Response to Cardiopulmonary Exercise Up to the Anaerobic Threshold in Patients with Subacute Myocardial Infarction

Overview

Journal Heart Vessels

Specialty Cardiology & Vascular Diseases

Date 2019 Jan 4

PMID 30604188

Citations 2

Authors

Shinji Nemoto

Yusuke Kasahara

Kazuhiro P Izawa

Satoshi Watanabe

Kazuya Yoshizawa

Naoya Takeichi

Kentaro Kamiya

Norio Suzuki

Kazuto Omiya

Atsuhiko Matsunaga

Yoshihiro J Akashi

Affiliations

Soon will be listed here.

Abstract

Resting heart rate (HR) plus 20 or 30 beats per minute (bpm), i.e., a simplified substitute for HR at the anaerobic threshold (AT), is used as a tool for exercise prescription without cardiopulmonary exercise testing data. While resting HR plus 20 bpm is recommended for patients undergoing beta-blocker therapy, the effects of specific beta blockers on HR response to exercise up to the AT (ΔAT HR) in patients with subacute myocardial infarction (MI) are unclear. This study examined whether carvedilol treatment affects ΔAT HR in subacute MI patients. MI patients were divided into two age- and sex-matched groups [carvedilol (+), n = 66; carvedilol (-), n = 66]. All patients underwent cardiopulmonary exercise testing at 1 month after MI onset. ΔAT HR was calculated by subtracting resting HR from HR at AT. ΔAT HR did not differ significantly between the carvedilol (+) and carvedilol (-) groups (35.64 ± 9.65 vs. 34.67 ± 11.68, P = 0.604). Multiple regression analysis revealed that old age and heart failure after MI were significant predictors of lower ΔAT HR (P = 0.039 and P = 0.013, respectively), but not carvedilol treatment. Our results indicate that carvedilol treatment does not affect ΔAT HR in subacute MI patients. Therefore, exercise prescription based on HR plus 30 bpm may be feasible in this patient population, regardless of carvedilol use, without gas-exchange analysis data.

Citing Articles

Agreement between heart rate at first ventilatory threshold on treadmill and at 6-min walk test in coronary artery disease patients on β-blockers treatment.

Calegari L, Moreira I, Falkowski A, Reolao J, Karsten M, Fernando Deresz L J Exerc Rehabil. 2021; 17(5):362-368.

PMID: 34805026 PMC: 8566104. DOI: 10.12965/jer.2142488.244.

Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction.

Nemoto S, Kasahara Y, Izawa K, Watanabe S, Yoshizawa K, Takeichi N Int J Environ Res Public Health. 2019; 16(16).

PMID: 31398919 PMC: 6720421. DOI: 10.3390/ijerph16162838.

References

Dargie H . Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001; 357(9266):1385-90. DOI: 10.1016/s0140-6736(00)04560-8. View

Strzelczyk T, Quigg R, Pfeifer P, Parker M, Greenland P . Accuracy of estimating exercise prescription intensity in patients with left ventricular systolic dysfunction. J Cardiopulm Rehabil. 2001; 21(3):158-63. DOI: 10.1097/00008483-200105000-00007. View

Taylor R, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K . Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004; 116(10):682-92. DOI: 10.1016/j.amjmed.2004.01.009. View

Kasahara Y, Izawa K, Omiya K, Osada N, Watanabe S, Saitoh M . Influence of autonomic nervous dysfunction characterizing effect of diabetes mellitus on heart rate response and exercise capacity in patients undergoing cardiac rehabilitation for acute myocardial infarction. Circ J. 2006; 70(8):1017-25. DOI: 10.1253/circj.70.1017. View

Tabet J, Meurin P, Ben Driss A, Thabut G, Weber H, Renaud N . Determination of exercise training heart rate in patients on beta-blockers after myocardial infarction. Eur J Cardiovasc Prev Rehabil. 2006; 13(4):538-43. DOI: 10.1097/01.hjr.0000209813.05573.4d. View

Hogarth A, Mackintosh A, Mary D . The sympathetic drive after acute myocardial infarction in hypertensive patients. Am J Hypertens. 2006; 19(10):1070-6. DOI: 10.1016/j.amjhyper.2006.03.015. View

Vittorio T, Zolty R, Kasper M, Khandwalla R, Hirsh D, Tseng C . Differential effects of carvedilol and metoprolol succinate on plasma norepinephrine release and peak exercise heart rate in subjects with chronic heart failure. J Cardiovasc Pharmacol Ther. 2008; 13(1):51-7. DOI: 10.1177/1074248407312629. View

Phan T, Shivu G, Abozguia K, Davies C, Nassimizadeh M, Jimenez D . Impaired heart rate recovery and chronotropic incompetence in patients with heart failure with preserved ejection fraction. Circ Heart Fail. 2009; 3(1):29-34. DOI: 10.1161/CIRCHEARTFAILURE.109.877720. View

Saito M, Kawana J, Ohno T, Hanada K, Kaneko M, Mihara K . Population pharmacokinetics of R- and S-carvedilol in Japanese patients with chronic heart failure. Biol Pharm Bull. 2010; 33(8):1378-84. DOI: 10.1248/bpb.33.1378. View

10.

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M . European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted.... Eur Heart J. 2012; 33(13):1635-701. DOI: 10.1093/eurheartj/ehs092. View

11.

. Guidelines for Secondary Prevention of Myocardial Infarction (JCS 2011). Circ J. 2012; 77(1):231-48. DOI: 10.1253/circj.cj-66-0053. View

12.

Hori M, Nagai R, Izumi T, Matsuzaki M . Efficacy and safety of bisoprolol fumarate compared with carvedilol in Japanese patients with chronic heart failure: results of the randomized, controlled, double-blind, Multistep Administration of bisoprolol IN Chronic Heart Failure II (MAIN-CHF.... Heart Vessels. 2013; 29(2):238-47. DOI: 10.1007/s00380-013-0340-3. View

13.

Diaz-Buschmann I, Villelabeitia Jaureguizar K, Calero M, Sanchez Aquino R . Programming exercise intensity in patients on beta-blocker treatment: the importance of choosing an appropriate method. Eur J Prev Cardiol. 2013; 21(12):1474-80. DOI: 10.1177/2047487313500214. View

14.

Wasserman K, Beaver W, Whipp B . Gas exchange theory and the lactic acidosis (anaerobic) threshold. Circulation. 1990; 81(1 Suppl):II14-30. View

15.

White D, Raven P . Autonomic neural control of heart rate during dynamic exercise: revisited. J Physiol. 2014; 592(12):2491-500. PMC: 4080933. DOI: 10.1113/jphysiol.2014.271858. View

16.

. Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012). Circ J. 2014; 78(8):2022-93. DOI: 10.1253/circj.cj-66-0094. View

17.

Ozemek C, Whaley M, Finch W, Kaminsky L . High Cardiorespiratory Fitness Levels Slow the Decline in Peak Heart Rate with Age. Med Sci Sports Exerc. 2015; 48(1):73-81. DOI: 10.1249/MSS.0000000000000745. View

18.

Reed J, Blais A, Keast M, Pipe A, Reid R . Performance of Fixed Heart Rate Increment Targets of 20 vs 30 Beats per Minute for Exercise Rehabilitation Prescription in Outpatients With Heart Failure. Can J Cardiol. 2017; 33(6):777-784. DOI: 10.1016/j.cjca.2017.01.022. View

19.

Watanabe H, Ozasa N, Morimoto T, Shiomi H, Bingyuan B, Suwa S . Long-term use of carvedilol in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. PLoS One. 2018; 13(8):e0199347. PMC: 6112626. DOI: 10.1371/journal.pone.0199347. View

20.

Beaver W, Wasserman K, Whipp B . A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol (1985). 1986; 60(6):2020-7. DOI: 10.1152/jappl.1986.60.6.2020. View