Effect of resting heart rate on two-year clinical outcomes of high-risk patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation.

O'Sullivan, Crochan J; Spitzer, Ernest; Heg, Dik; Praz, Fabien; Stortecky, Stefan; Huber, Christoph; Carrel, Thierry; Pilgrim, Thomas; Windecker, Stephan (2016). Effect of resting heart rate on two-year clinical outcomes of high-risk patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation. EuroIntervention, 12(4), pp. 490-498. Europa Digital & Publishing 10.4244/EIJV12I4A83

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AIMS Resting heart rate (HRate) is a modifiable risk factor among patients with cardiovascular disease, including aortic stenosis (AS). However, the effect of resting HRate on clinical outcomes of patients with severe symptomatic AS undergoing transcatheter aortic valve implantation (TAVI) is unknown. Our aim was therefore to assess the effect of resting HRate on clinical outcomes among high-risk patients with symptomatic severe AS in normal sinus rhythm (NSR) undergoing TAVI. METHODS AND RESULTS Of 606 consecutive patients undergoing TAVI, 349 (57.6%) with severe AS and a baseline 12-lead electrocardiogram (ECG) showing NSR undergoing TAVI were analysed. Patients were dichotomised into low HRate (LHR; <77 beats per minute [bpm]) and high HRate (HHR; ≥77 bpm) groups. The primary endpoint was all-cause mortality at two years. As compared with baseline LHR, no significant differences in all-cause mortality at two years (adjusted [adj] hazard ratio [HR] 1.23, p=0.40) were observed among patients with baseline HHR. Of 197 patients with available discharge ECGs remaining in NSR, mean HRate significantly increased among LHR patients (∆HRate 8.35, p<0.001) but decreased among HHR patients (∆HRate -4.88, p<0.001). On thirty-day landmark analysis, discharge HHR was significantly associated with two-year all-cause mortality (HR 2.30, 95% CI: 1.16-4.56, p=0.017), but not after extensive adjustment for comorbidities (adj HR 2.01, 95% CI: 0.98-4.09, p=0.056). A significant interaction for two-year mortality (p-interaction 0.021) was observed on landmark analysis for discharge, but not baseline, HHR. CONCLUSIONS Baseline and discharge resting HRate were not associated with adverse outcomes after TAVI.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

O'Sullivan, Crochan John; Heg, Dierik Hans; Praz, Fabien; Stortecky, Stefan; Huber, Christoph; Carrel, Thierry; Pilgrim, Thomas and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1774-024X

Publisher:

Europa Digital & Publishing

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

04 Aug 2016 15:55

Last Modified:

08 Sep 2017 16:20

Publisher DOI:

10.4244/EIJV12I4A83

PubMed ID:

27436601

BORIS DOI:

10.7892/boris.85606

URI:

https://boris.unibe.ch/id/eprint/85606

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