heart rate and the cardiovascular system: the role of...

Heart Rate and the Cardiovascular

System: The Role of ExerciseSystem: The Role of Exercise

Harisios Boudoulas, Dr, Dr HonHarisios Boudoulas, Dr, Dr HonProfessor, Academician (an. mem.)

The Ohio State University, Columbus, Ohio, USA

Biomedical Research Foundation, Academy of Athens, GreeceBiomedical Research Foundation, Academy of Athens, Greece

Semilogarithmic relation between rest heart rate and life expectancy in

mammals

Levine HJ, JACC 1997; 30: 1104$6

Relation between life expectancy and total heart beats/lifetime among

mammalsThe image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again.

Levine HJ, JACC 1997; 30: 1104%6

Effects of Heart Rate on the HeartEffects of Heart Rate on the Heart

Circadian variations of heart rate in office workers (16�65 years)

Clarke et al. Lancet 1976; 2: 508

Relationship between heart rate and

diastolic time

Cardiac Cycle: left ventricular (LV) work

and left coronary (L Cor) flow diastolic timeand left coronary (L Cor) flow

QS2 (Duration

of systole)of systole)

Boudoulas H et al. Circulation 1979; 60: 164

Collateral Flow is diastolic

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Boudoulas H, MMG 1979; 7: 405�417

Effects of heart rate on the arteries

Other abnormalities associated with high heart rate affecting the arterial system

• High adrenergic activity

• Inflammation

• Oxidative stress

• Endothelial dysfunction

• Proteinuria• Proteinuria

• High insulin (resistance)

Thorin E et al. Cardiovascular Research 2009; 84: 24(32

Vascular endothelial aging, heart beat after heart beat; stress and repair starts in utero.

Palatini P et al. Hypertension 1997; 30: 1267(1273

Aortic function: storage capacity, pulse wave velocity,

arteriolar functionarteriolar function

Aortic function: reflected wave, aortic pulse wave

Relations between aortic pressure waves (central aortic pressure) and

heart rate

Retarding effect of lowering heart rate on atherosclerosis

Maximum Stenosis (%)

55.9 ± 2355.9 ± 23

26.1 ± 18

High Heart Rate Low Heart Rate

Baere, Glagoc, Zarins. Science 1984; 226: 180

Rate of developing sustained hypertension by age according to the

presence or absence of transient tachycardia and transient hypertension

Levy, White, Strand. JAMA 1945; 129: 585#588

Heart rate and mortality in healthy men

Jouven X et al. N Engl J Med 2005;352: 1951�8

Heart rate and mortality in coronary artery disease

Diaz A et al. Eur Heart J 2005; 26: 967�74

Total mortality in patients with AMI from day 2 to 1 year for

patients on or not on β�blockerspatients on or not on β�blockers

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< 70 ≥ 9070�89

Hjalmarson A et al. Am J Cardiol 1990; 65: 547�553

Anton LM et al. Eur Heart J 2012; 33: 96�102

Relation between changes in heart rate (decrease), diastolic time

(increase) and mortality in post�myocardial infarction patients(increase) and mortality in post�myocardial infarction patients

Kjekshus J. Eur Heart J 1985; 6 (Suppl A): 29�30 Boudoulas H. Acta Cardiologica 1991; 46: 61�71Kjekshus J. Eur Heart J 1985; 6 (Suppl A): 29�30 Boudoulas H. Acta Cardiologica 1991; 46: 61�71

Patients with coronary artery disease, stable angina and

heart rate > 70 beats per minuteheart rate > 70 beats per minute

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Fox K et al. Lancet 2008; 372:807016

Olympic Anthem

Effects of exercise on cardiovascular system

Olympic Anthem

“Αρχαίο πνεύ α αθάνατο,

αγνέ πατέρα, του εγάλου, του αγνέ πατέρα, του εγάλου, του

ωραίου και τ’ αληθινού…”

Κ.Παλα�άςΚ.Παλα�άς

“ Ancient immortal spirit,

father of everything that is

beautiful, great and true…”

K.Palamas

ΝΕΝΙΚΗΚΑΜΕΝ(We have won)

ΦΕΙ∆ΙΠΠΙ∆ΗΣ 530 BC – 490 BCΦΕΙ∆ΙΠΠΙ∆ΗΣ 530 BC – 490 BC

Pheidippides

Cardiac arrest during long�distance running races. Kim JH. N Engl J Med 2012; 366: 130�140

Effect of aerobic and strength (resistance) exercise on heart rate and blood pressure.

Aerobic: heart rate

Women

Strength: blood pressure (BP)

MenMen

Feldman M, Elettereades J. Triggers of Aortic Dissections.

In Boudoulas H, Stefanadis C eds.

The Aorta: Structure, Function, Dysfunction and Diseases.

Informa Healthcare USA, Inc., New York, NY, 2009

Körperlicher Belastung, Steinkopff, Darmstadt 1984,

p 62 Gleichmann V in Anlaut and Bock eds.

Relative risk of myocardial infarction (MI) according to the usual frequency

of heavy exercise

Mittleman et al. N Engl J Med 1993; 324: 1677&83

Role of exercise or emotional stress in precipitating acute aortic dissection

Feldman M, Elettereades J. Triggers of Aortic Dissections. In Boudoulas H, Stefanadis C eds.

The Aorta: Structure, Function, Dysfunction and Diseases. Informa Healthcare USA, Inc., New York, NY, 2009

Pressure wave recordings during running

The rhythm of running: Can the heart join in?

• Heart Rate (HR) and

Step Rate Synchronized

The rhythm of running: Can the heart join in?

Step Rate Synchronized

• HR and Body Wave in Phase

• HR and Step Rate

SynchronizedSynchronized

• HR and Body Wave Out of

Phase

• Rest Alter Exercise

O’Rourke M et al. Aust NZ J Med 1993; 23: 708

Compliance in the ascending aorta displayed on a logarithmic scale and

plotted against age

Mohiaddin RH. Br Heart J 1989; 62: 90�6

Effects of chronic aerobic exercise on

cardiovascular systemcardiovascular system

• ↓ Heart rate• ↓ Heart rate

• ↓ Adrenergic activity

• Improves endothelial function• Improves endothelial function

• ↓ Insulin (insulin resistance)

• ↓ Pulse wave velocity

• ↓ Reflected wave velocity (central aortic pressure)• ↓ Reflected wave velocity (central aortic pressure)

Why heart rate is increased ?Why heart rate is increased ?

Relation between body weight and total heart beats/lifetime

among mammalsamong mammals

Levine HJ. JACC 1997; 30: 1104"6

Body surface area (BSA) / body weight (BWt) in different

size animals

100 –

size animals

• The ratio of heat loss (a function

of body surface area) to heat

production (a function of body

mass) increases as body weight is 100 –

#

80 –

#

mass) increases as body weight is

reduced.

• Mammals with large body surface

area in relation to body weight #

60 –

#BSA/BWt

Infant3.5 Kg

area in relation to body weight

(small) need to increase the

metabolic rate in order to maintain

constant body temperature.

40 –

#

20 –

Adult75 Kg

• Higher metabolic needs in

animals with large body surface

area in relation to weight result in

fast heart rate.20 –

#

0 –

1 10 100 1000

fast heart rate.

1

Body Weight (Kg)

10 100 1000

RR interval association results for ~ 2.5 million imputed autosomal SNPs in

38,991 individuals from 15 cohorts38,991 individuals from 15 cohorts

Other abnormalities associated with fast heart rate

• High adrenergic activity

• Inflammation

• Oxidative stress

Eijgelsheim M et al. Hum Mol Genet 2010; 19: 3885/94

• Oxidative stress

• Endothelial dysfunction

• Proteinuria

• High insulin (resistance)

High heart rate: Therapeutic considerationsHigh heart rate: Therapeutic considerations

• Apparently healthy individuals:• Apparently healthy individuals:

– Regular aerobic exercise “ΜΗ∆ΕΝ ΑΓΑΝ”

– Avoid stimulants (caffeine, alcohol, other)

– Maintain normal body weight

• Patients with underlying disease:• Patients with underlying disease:

– Management of the disease using current knowledge

and common senseand common sense

– Regular exercise when appropriate

Effect of heart rate on cardiovascular system:

Concluding remarksConcluding remarks

• Fast heart rate may reflect high metabolic needs in • Fast heart rate may reflect high metabolic needs in

different species and in certain conditions and diseases

in humans

• Fast heart rate:• Fast heart rate:

– Decreases coronary flow and increases LV work

– Is associated with high adrenergic tone, proteinuria,

inflammation and endothelial dysfunction

– Is associated with faster PWV– Is associated with faster PWV

– Is associated with higher cardiovascular and all cause

mortalitymortality

Effect of heart rate on cardiovascular system:

Concluding remarksConcluding remarks

• Reduction in heart rate:• Reduction in heart rate:

– May slow the progression of atherosclerosis

– Is associated with decrease cardiovascular mortality – Is associated with decrease cardiovascular mortality

– May result in an increase in central aortic pressure

Effects of heart rate on cardiovascular system –

the role of exercise: Concluding remarksthe role of exercise: Concluding remarks

Chronic aerobic exerciseChronic aerobic exercise

• ↓ Heart rate

• ↓ Adrenergic activity• ↓ Adrenergic activity

• ↓ Insulin (insulin resistance)

• Improves endothelial function

• ↓ Pulse wave velocity• ↓ Pulse wave velocity

• ↓ Reflected wave velocity (central aortic pressure)

Genetics, body area/weight, adrenergic activity/insulin, other

Heart rate and the cardiovascular system

Genetics, body area/weight, adrenergic activity/insulin, other

Metabolic needs

↑ Heart rate

↑ LV work↑ LV work

LVH/failure

• Oxidative stress

• Inflammation

• Endothelial damage

↓ Diastolic time

↑ Systolic time

Myocardial

ischemiaAging

Stiff vessels

↑ LV work

↓ Myocardial perfusion

• Atherosclerosis

• Hypertension

• Organ damage

(brain, kidney)

Stiff vessels

↑ Pulse wave/reflected

wave velocity

Stiff aorta

(brain, kidney)