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June 12, 2026European Journal of Preventive CardiologyOpen Access

When there is no consensus definition: the case of chronotropic incompetence

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Why the study?

How do different diagnostic criteria for chronotropic incompetence affect its identification and agreement in patients undergoing cardiac rehabilitation?

Population

2,869 patients enrolling in a cardiac rehabilitation program

Design

Cohort

Authors

MVM VermeirenRWR I K WillemsKGK Goetschalckx

Discussion

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Overview

CI prevalence in cardiac rehab varies widely by definition; leaves open optimal metric for risk stratification.

Key Points

  • This study aimed to analyze various definitions of chronotropic incompetence and their effects on patient identification during cardiac rehabilitation.
  • Retrospective assessment of 2,869 patients in a cardiac rehabilitation program.
  • Measurement of CI using four definitions: APMHR, HRR, CIx at VT1, and peak HR slope.
  • Agreement among definitions evaluated using McNemar tests (p<0.05).
  • 33.6% classified with CI using APMHR, 46.8% using HRR, 72.4% using CIx at VT1, and 5.7% using peak HR slope.
  • Significant differences in CI classification across definitions (all p<0.001).
  • Similar discrepancies noted in patients achieving maximal effort, ranging from 3.5% (peak HR slope) to 69.9% (CIx at VT1).

Structured PICO

How do different diagnostic criteria for chronotropic incompetence affect its identification and agreement in patients undergoing cardiac rehabilitation?

P
Population
2,869 patients enrolling in a cardiac rehabilitation program
I
Intervention
Assessment of chronotropic incompetence using four established definitions (<85% of APMHR, HRR <80%, CIx <0.8 at VT1, and peak HR slope method) during cardiopulmonary exercise testing
O
Outcome
Proportion of patients classified as having chronotropic incompetence and agreement between definitionssurrogate

The diagnosis of chronotropic incompetence varies drastically depending on the criteria used, emphasizing the urgent need for a standardized universal definition.

Cite This Study

Vermeiren et al. (2026) studied this question.

synapsesocial.com/papers/6a2bd1386550ea4541ffe989https://doi.org/10.1093/eurjpc/zwag249.306
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