Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: The SEAS study

被引:14
|
作者
Greve, Anders M. [1 ]
Bang, Casper N. [1 ]
Berg, Ronan M. G. [2 ]
Egstrup, Kenneth [3 ]
Rossebo, Anne B. [4 ]
Boman, Kurt [5 ]
Nienaber, Christoph A. [6 ]
Ray, Simon [7 ]
Gohlke-Baerwolf, Christa [8 ]
Nielsen, Olav W. [9 ]
Okin, Peter M. [10 ]
Devereux, Richard B. [10 ]
Kober, Lars [1 ]
Wachtell, Kristian [10 ,11 ]
机构
[1] Rigshosp, Ctr Heart, Dept Med B, DK-2100 Copenhagen, Denmark
[2] Rigshosp, Dept Clin Physiol Nucl Med & PET, DK-2100 Copenhagen, Denmark
[3] OUH Svendborg Sygehus, Med Afdeling, Svendborg, Denmark
[4] Oslo Univ Hosp, Dept Cardiol, Oslo, Norway
[5] Umea Univ, Dept Med, Inst Publ Hlth & Clin Med, Skellefta, Sweden
[6] Rostock Sch Med, Univ Heart Ctr Rostock, Dept Cardiol & Angiol, Rostock, Germany
[7] Manchester Acad Hlth Sci Ctr, Manchester, Lancs, England
[8] Herz Zentrum Bad Krozingen, Bad Krozingen, Germany
[9] Bispebjerg Hosp, Copenhagen, Denmark
[10] Weill Cornell Med Coll, New York, NY USA
[11] Glostrup Univ Hosp, Copenhagen, Denmark
关键词
Aortic valve stenosis; Resting heart rate; Risk stratification; LEFT-VENTRICULAR HYPERTROPHY; FORCE-FREQUENCY-RELATIONSHIP; CARDIAC RYANODINE RECEPTOR; CORONARY-ARTERY-DISEASE; ECHOCARDIOGRAPHIC-ASSESSMENT; CHAMBER QUANTIFICATION; HYPERTENSIVE PATIENTS; VALVE STENOSIS; ALL-CAUSE; FAILURE;
D O I
10.1016/j.ijcard.2014.11.181
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown. Methods: RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se. Results: 1563 patients were followed for a mean of 4.3 years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n = 151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10 min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10 min(-1) faster, 95% CI: 1.0-1.7, both p <= 0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10 min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10 min(-1) faster, 95% CI: 1.2-1.7, both p <= 0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p >= 0.06 for interaction). Conclusions: RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677). (C) 2014 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:122 / 128
页数:7
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