Dataset Information

Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure.

ABSTRACT:

Background

The prognostic value of the change in heart rate from the supine to upright position (?HR) in patients with chronic heart failure (HF) is unknown.

Methods and results

?HR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME-CHF) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ?HR on 18-month outcome (HF hospitalization-free survival) was assessed. In addition, the prognostic effect of changes in ?HR between baseline and month 6 on outcomes in the following 12 months was determined. A lower ?HR was associated with a higher risk of death or HF hospitalization (hazard ratio 1.79 [95% confidence interval {95% CI} 1.19-2.75] if ?HR ?3 beats/min [bpm], P=0.004). In the multivariate analysis, lower ?HR remained an independent predictor of death or HF hospitalization (hazard ratio 1.75 [95% CI, 1.18-2.61] if ?HR ?3 bpm, P=0.004) along with ischemic HF etiology, lower estimated glomerular filtration rate, presence and extent of rales, and no baseline ?-blocker use. In patients without event during the first 6 months, the change in ?HR from baseline to month 6 predicted death or HF hospitalization during the following 12 months (hazard ratio=2.13 [95% CI 1.12-5.00] if rise in ?HR <2 bpm; P=0.027).

Conclusions

?HR as a simple bedside test is an independent prognostic predictor in patients with chronic HF. ?HR is modifiable, and changes in ?HR also provide prognostic information, which raises the possibility that ?HR may help to guide treatment.

Clinical trial registration information

URL: www.isrctn.org. Unique identifier: ISRCTN43596477.

SUBMITTER: Maeder MT

PROVIDER: S-EPMC5015278 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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Publications

Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure.

Maeder Micha T MT Zurek Marzena M Rickli Hans H Tobler Daniel D Kiencke Stephanie S Suter Thomas T Yoon Se-Il SI Julius Barbara B Pfisterer Matthias E ME Brunner-La Rocca Hans-Peter HP

Journal of the American Heart Association 20160808 8

<h4>Background</h4>The prognostic value of the change in heart rate from the supine to upright position (∆HR) in patients with chronic heart failure (HF) is unknown.<h4>Methods and results</h4>∆HR was measured in patients enrolled in the Trial of Intensified Medical Therapy in Elderly Patients with Congestive Heart Failure (TIME-CHF) who were in sinus rhythm and had no pacemaker throughout the trial (n=321). The impact of ∆HR on 18-month outcome (HF hospitalization-free survival) was assessed. I ...[more]

PMID: 27503849

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Project description:BackgroundWe investigated whether repeatedly measured global longitudinal strain (GLS) has incremental prognostic value over repeatedly measured left ventricular ejection fraction (LVEF) and N-terminal pro B-type natriuretic peptide (NT-proBNP), and a single "baseline" GLS value, in chronic heart failure (HF) patients.MethodsIn this prospective observational study, echocardiography was performed in 173 clinically stable chronic HF patients every six months during follow up. During a median follow-up of 2.7 years, a median of 3 (25th-75th percentile:2-4) echocardiograms were obtained per patient. The endpoint was a composite of HF hospitalization, left ventricular assist device, heart transplantation, cardiovascular death. We compared hazard ratios (HRs) for the endpoint from Cox models (used to analyze the first available GLS measurements) with HRs from joint models (which links repeated measurements to the time-to-event data).ResultsMean age was 58 ± 11 years, 76% were men, 81% were in New York Heart Association functional class I/II, and all had LVEF < 50% (mean ± SD: 27 ± 9%). The endpoint was reached by 53 patients. GLS was persistently decreased over time in patients with the endpoint. However, temporal GLS trajectories did not further diverge in patients with versus without the endpoint and remained stable during follow-up. Both single measurements and temporal trajectories of GLS were significantly associated with the endpoint [HR per SD change (95%CI): 2.15(1.34-3.46), 3.54 (2.01-6.20)]. In a multivariable model, repeatedly measured GLS maintained its prognostic value while repeatedly measured LVEF did not [HR per SD change (95%CI): GLS:4.38 (1.49-14.70), LVEF:1.14 (0.41-3.23)]. The association disappeared when correcting for repeatedly measured NT-proBNP.ConclusionTemporal evolution of GLS was associated with adverse events, independent of LVEF but not independent of NT-proBNP. Since GLS showed decreased but stable values in patients with adverse prognosis, single measurements of GLS provide sufficient information for determining prognosis in clinical practice compared to repeated measurements, and temporal GLS patterns do not add prognostic information to NT-proBNP.

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Dataset Information

Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure.

Background

Methods and results

Conclusions

Clinical trial registration information

Publications

Prognostic Value of the Change in Heart Rate From the Supine to the Upright Position in Patients With Chronic Heart Failure.

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