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).
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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)
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Copyright | Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. |
Chemical References |
- Anticholesteremic Agents
- Azetidines
- Simvastatin
- Ezetimibe
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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
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