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

Published online by Cambridge University Press:  02 November 2015

Paulo Peres ,
Antônio C. Carvalho Open the ORCID record for Antônio C. Carvalho [Opens in a new window] ,
Ana Beatriz A. Perez  and
Wladimir M. Medeiros Open the ORCID record for Wladimir M. Medeiros [Opens in a new window]
Paulo Peres
Affiliation:
Department of Cardiology, Federal University of São Paulo, São Paulo, Brasil Department of Physiotherapy, Nove de Julho University, São Paulo, Brasil
Antônio C. Carvalho
Affiliation:
Department of Cardiology, Federal University of São Paulo, São Paulo, Brasil
Ana Beatriz A. Perez
Affiliation:
Medical Genetics Center, Federal University of São Paulo, São Paulo, Brasil Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brasil
Wladimir M. Medeiros*
Affiliation:
Department of Cardiology, Federal University of São Paulo, São Paulo, Brasil Pneumology Department, Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Federal University of São Paulo, São Paulo, Brasil
*
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
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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.

Keywords

Marfan syndromeheart ratephysical exerciseautonomic functionmortality
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1274 - 1281
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Copyright
© Cambridge University Press 2015 

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