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

Abstract

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 4.3years (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 10min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10min(-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 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-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).

• Authors: Anders M Greve, Casper N Bang, Ronan M G Berg, Kenneth Egstrup, Anne B Rossebø, Kurt Boman, Christoph A Nienaber, Simon Ray, Christa Gohlke-Baerwolf, Olav W Nielsen, Peter M Okin, Richard B Devereux, Lars Køber, Kristian Wachtell
• Journal: International journal of cardiology (Int J Cardiol) Vol. 180 Pg. 122-8 (Feb 01 2015) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 25438232 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Anticholesteremic Agents
• Azetidines
• Simvastatin
• Ezetimibe

Topics

• Aged
• Anticholesteremic Agents (therapeutic use)
• Aortic Valve Stenosis (complications, drug therapy, physiopathology)
• Atrial Fibrillation (epidemiology, etiology, physiopathology)
• Azetidines (therapeutic use)
• Double-Blind Method
• Drug Therapy, Combination
• Ezetimibe
• Female
• Follow-Up Studies
• Global Health
• Heart Failure (epidemiology, etiology, physiopathology)
• Heart Rate (physiology)
• Humans
• Male
• Middle Aged
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Rest (physiology)
• Simvastatin (therapeutic use)
• Survival Rate (trends)
• Time Factors