Heart failure & cardiomyopathiesCohort study
Chronotropic response in heart failure: clinical, structural, and metabolic predictors and long-term mortality
- Prospective cohort study
Authors' conclusion
Chronotropic incompetence was a strong predictor of clinical outcomes.
Study context
- Population
- Subjects of the MyoVasc study with deep clinical phenotyping including cardiopulmonary exercise testing (CPET) (heart failure (HF) and at risk); respiratory exchange ratio < 1.0 excluded377 with symptomatic HF
- Participants
- 880 subjects
- Exposure
- Chronotropic incompetence and clinical outcomes
- Outcome
- All-cause death, cardiac death and worsening of HF by CI (pHRR)
Main finding
As reported in the abstract
Clinical outcomes per SD decrease in pHRR
per SD decrease in pHRRHazard ratio (CI)P value
all-cause death
1.77(1.42–2.21)
P < 0.0001cardiac death
1.74(1.08–2.80)
P = 0.023worsening of HF
1.39(1.01–1.91)
P = 0.046Per SD decrease in pHRR, as printed
Observational data: associations, not effects.
Further findings
Prevalence and definition of CI
- Chronotropic incompetent by traditional 80% threshold
- 64.7% (n = 569)
- New reference-range CI definition
- Predicted heart rate reserve (pHRR) < 56.4%
Determinants of CI
- Determinants included peak VO2, β-blockers, age, sex, smoking, CPET protocol, HF severity, C-peptide and fatty liver
- No phenotype-specific pattern of CI determinants
Original publication
Chronotropic response in heart failure: clinical, structural, and metabolic predictors and long-term mortality. Eur J Heart Fail. Published 16 June 2026. doi:10.1093/ejhf/xuag139
Summarised from the published abstract; every number is checked against it