Kidney Week

Abstract: TH-PO0319

Chronotropic Incompetence Is a Contributor to Cardiovascular Functional Impairment in Patients with Heart Failure with Preserved Ejection Fraction and CKD

Session Information

• Hypertension and CVD: Clinical - 1
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Campos, Monique Opuszcka, Indiana University School of Medicine, Indianapolis, Indiana, United States

Monique Opuszcka Campos, PhD

• Narayanan, Gayatri, Indiana University School of Medicine, Indianapolis, Indiana, United States

Gayatri Narayanan, MS

• Groninger, Nolan, Indiana University School of Medicine, Indianapolis, Indiana, United States

Nolan Groninger, MPH

• Burney, Heather, Indiana University School of Medicine, Indianapolis, Indiana, United States

Heather Burney, MS

• Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States

Kenneth Lim, MD, PhD, FASN

Background

Chronotropic incompetence (CI) is a hallmark of heart failure with preserved ejection fraction (HFpEF), the predominant HF phenotype in chronic kidney disease (CKD). CI has been linked with impaired cardiovascular functional capacity (CVC) in the general population, however CI in CKD remains largely unstudied. Herein, we investigated the role of CI with moderate-to-severe decrements in kidney function and its link with VO₂Peak (gold-standard index of CVC) in HFpEF patients from the RELAX trial.

Methods

We conducted a cross-sectional analysis of baseline data from 213 participants in the RELAX trial: a double-blind, randomized trial comparing sildenafil vs placebo in patients with HFpEF (NYHA class II–III). All participants underwent cardiopulmonary exercise testing (CPET). We stratified the cohort into tertiles by peak heart rate (HRPeak): >119bpm, 97-118bpm and <96bpm. Group differences were assessed by ANOVA , Kruskal-Wallis, or chi-square tests. Inferential analysis was conducted using Pearson’s correlation analysis and multiple linear regression.

Results

Groups were well-matched by gender and BMI (all P’s>0.05). Patients with lower HRPeak (<96bpm) were older and had more comorbidities, including hypertension, dyslipidemia, pacemaker use, and higher beta-blocker use (all P’s<0.05). CKD was most prevalent in this group (62.3%), with lower eGFR than higher HRPeak tertiles (>119 bpm: 64.0 [50.3, 82.0] mL/min/1.73m² vs 97-118 bpm: 57.4 [43.2, 76.2] mL/min/1.73m² and 60–96 bpm: 48.3 [37.6; 62.0] mL/min/1.73m2, P<0.001). Significantly, VO₂Peak was impaired in the lowest HRPeak tertile (10.5±2.3 mL/min/kg, P<0.001) versus the highest tertile (13.7±3.1 mL/min/kg). Maximal workload and endurance time were also significantly reduced in the lower tertiles (all P<0.001). HRPeak showed positive correlations with eGFR (r=0.27) and VO₂Peak (r=0.41; both P<0.001), and remained independently associated with VO₂Peak after adjusting for age, sex, eGFR, beta-blocker use, diabetes, and ejection fraction.

Conclusion

CI commonly affects HFpEF patients with CKD and is associated with impaired in VO₂Peak.

Funding

• Private Foundation Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20256mb633ht