Effect of carvedilol on heart rate response to cardiopulmonary exercise up to the anaerobic threshold in patients with subacute myocardial infarction

  • Shinji Nemoto
  • Yusuke Kasahara
  • Kazuhiro P. Izawa
  • Satoshi Watanabe
  • Kazuya Yoshizawa
  • Naoya Takeichi
  • Kentaro Kamiya
  • Norio Suzuki
  • Kazuto Omiya
  • Atsuhiko Matsunaga
  • Yoshihiro J. AkashiEmail author
Original Article


Resting heart rate (HR) plus 20 or 30 beats per minute (bpm), i.e., a simplified substitute for HR at the anaerobic threshold (AT), is used as a tool for exercise prescription without cardiopulmonary exercise testing data. While resting HR plus 20 bpm is recommended for patients undergoing beta-blocker therapy, the effects of specific beta blockers on HR response to exercise up to the AT (ΔAT HR) in patients with subacute myocardial infarction (MI) are unclear. This study examined whether carvedilol treatment affects ΔAT HR in subacute MI patients. MI patients were divided into two age- and sex-matched groups [carvedilol (+), n = 66; carvedilol (−), n = 66]. All patients underwent cardiopulmonary exercise testing at 1 month after MI onset. ΔAT HR was calculated by subtracting resting HR from HR at AT. ΔAT HR did not differ significantly between the carvedilol (+) and carvedilol (−) groups (35.64 ± 9.65 vs. 34.67 ± 11.68, P = 0.604). Multiple regression analysis revealed that old age and heart failure after MI were significant predictors of lower ΔAT HR (P = 0.039 and P = 0.013, respectively), but not carvedilol treatment. Our results indicate that carvedilol treatment does not affect ΔAT HR in subacute MI patients. Therefore, exercise prescription based on HR plus 30 bpm may be feasible in this patient population, regardless of carvedilol use, without gas-exchange analysis data.


Myocardial infarction Beta blocker Anaerobic threshold Heart rate response Cardiac rehabilitation 



The authors thank the staff members of the Department of Rehabilitation Medicine and the Department of Cardiology at St. Marianna University School of Medicine Yokohama City Seibu Hospital for their assistance in data collection.


This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Shinji Nemoto
    • 1
    • 2
  • Yusuke Kasahara
    • 1
  • Kazuhiro P. Izawa
    • 3
  • Satoshi Watanabe
    • 4
  • Kazuya Yoshizawa
    • 1
  • Naoya Takeichi
    • 4
  • Kentaro Kamiya
    • 2
  • Norio Suzuki
    • 5
  • Kazuto Omiya
    • 6
  • Atsuhiko Matsunaga
    • 2
  • Yoshihiro J. Akashi
    • 6
    Email author
  1. 1.Department of Rehabilitation MedicineSt. Marianna University School of Medicine Yokohama City Seibu HospitalYokohamaJapan
  2. 2.Department of Rehabilitation SciencesKitasato University Graduate School of Medical SciencesSagamiharaJapan
  3. 3.Department of Public HealthKobe University Graduate School of Health SciencesKobeJapan
  4. 4.Department of Rehabilitation MedicineSt. Marianna University School of Medicine HospitalKawasakiJapan
  5. 5.Division of Cardiology, Department of Internal MedicineSt. Marianna University School of Medicine Yokohama City Seibu HospitalYokohamaJapan
  6. 6.Division of Cardiology, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan

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