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CLINICAL STUDIES

Chronotropic competence in endurance trained heart transplant recipients: heart rate is not a limiting factor for exercise capacity

Ruddy Richard, MD, PhD^*, Jean-Claude Verdier, MD^*, Alain Duvallet, MD^*, Sully-Pierre Rosier, MD^*, Philippe Leger, MD^b, Alexis Nignan, MD and Michel Rieu, MD, PhD^*

^* Département de Physiologie de la Faculté de Médecine Cochin-Port-Royal (Université René Descartes) and Service d’Explorations Fonctionnelles et de Physio-Pathologie de l’Exercice, Centre Hospitalier Cochin-Tarnier, 89 rue d’Assas, 75006, Paris, France
^b Service de Chirurgie Cardio-Vasculaire, Groupe Hospitalier La Pitié-Salpétrière, 75 Boulevard de l’Hôpital, 75013, Paris, France
Laboratoire de Biochimie A, Groupe Hospitalier Cochin, 27 Rue du Faubourg Saint-Jacques, 75679, Paris Cedex 14, France

Manuscript received May 12, 1998; revised manuscript received August 11, 1998, accepted September 15, 1998.

Address for correspondence: Dr. Ruddy Richard, Laboratoire de Physiologie des Adaptations, Faculté de Médecine Cochin-Port-Royal, 24 rue du Faubourg Saint-Jacques, 75014, Paris, France

Objectives. The purpose of this study was to show that the chronotropic potential of the well trained heart transplant recipient (HTR) does not limit exercise capacity.

Background. Chronotropic incompetence is considered to be the main limiting factor of the functional capacity of heart transplant recipients. However, no systematic study had been published on patients who had spontaneously undergone heavy endurance training for several years.

Methods. Heart rate (HR) and respiratory gas exchanges (VO₂, VCO₂, VE) were measured in 14 trained HTRs (T-HTRs) during exercise tests on a bicycle, on a treadmill and by Holter electrocardiography during a race.

Results. Peak values observed in T-HTRs during the treadmill test were higher than those reached during the bicycle test (VO_2peak: 39.8 ± 6.9 vs. 32.5 ± 7.8 ml·kg^–1·min^–1, p < 0.001; HR_peak: 169 ± 14 vs. 159 ± 16 bpm, p < 0.01). During treadmill exercise VO_2peak and HR_peak values observed were very close to the mean predicted VO_2pmax and HR_pmax. The maximum heart rate during the race (HR_race) was greater than HR_peak values during the treadmill test (179 ± 14 vs 169 ± 14 bpm, p < 0.01) and slightly above the mean predicted values (HR_race/HR_pmax x 100 = 101 ± 10%). The treadmill exercise test yields more reliable data than does the bicycle test.

Conclusions. Extensive endurance training enables heart transplant recipients to reach physical fitness levels similar to those of normal sedentary subjects; heart rate does not limit their exercise capacity.

Abbreviations and Acronyms   HR = Heart rate   HRpeak = Peak heart rate   HRpmax = Maximum predicted heart rate   HRrace = Maximum heart rate during the race   HTR = Heart transplant recipient   Pmax = Maximum work power   MET = Metabolic equivalent of the task   S-HTR = Sedentary heart transplant recipient   T-HTR = Trained heart transplant recipient   VO2peak = Peak oxygen uptake   VO2pmax = Maximum predicted oxygen uptake

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