A system and method for pacing rate control in a cardiac rhythm management (CRM) system. The method includes acquiring a pressure signal representative of coronary venous pressure (CVP) from a pressure sensor implanted within a coronary vein of the patient and generating a CVP waveform from the pressure signal. A pacing stimulus is applied to the patients heart, and the pacing rate is increased in response to increases in patients metabolic demand. The CVP index is monitored during the pacing rate increase, and the CRM system detects a reduction in the patients hemodymanic performance based on the CVP index and establishes a maximum rate setting based on the pacing rate corresponding to the reduction in the patients hemodynamic performance.
