Department of Heart, Vessel, Thorax, University Hospital of Zurich, Zurich, 8091, Switzerland.
Respir Res. 2012 Sep 3;13(1):76. doi: 10.1186/1465-9921-13-76.
A low resting heart rate (HR) is prognostically favourable in healthy individuals and in patients with left heart disease. In this study we investigated the impact of HR at diagnosis on long-term outcome in patients with differently classified precapillary pulmonary hypertension (pPH).
pPH patients diagnosed as pulmonary arterial (PAH) or inoperable chronic thromboembolic pulmonary hypertension (CTEPH) were registered and regularly followed at our centre Baseline characteristics and events defined as either death or lung transplantation were noted. The prognostic value of HR was analysed using Kaplan Meier estimates, live tables and Cox regression.
206 patients with PAH (148) and inoperable CTEPH (58) were included. The median HR was 82 bpm. pPH with a HR below 82 bpm had a significantly longer overall event-free survival (2409 vs.1332 days, p = .000). This advantage was similarly found if PAH and CTEPH were analysed separately. Although a lower HR was associated with a better hemodynamic and functional class, HR was a strong and independent prognostic marker for transplant free survival even if corrected for age, sex, hemodynamics and functional status.
We show that resting HR at diagnosis is a strong and independent long-term prognostic marker in PAH and CTEPH. Whether reducing HR by pharmacological agents would improve outcome in pPH has to be assessed by future trials with high attention to safety.
在健康个体和左心疾病患者中，较低的静息心率（HR）与预后良好相关。在这项研究中，我们研究了诊断时 HR 对不同分类的毛细血管前性肺动脉高压（pPH）患者长期预后的影响。
我们在中心登记了诊断为肺动脉高压（PAH）或不可手术的慢性血栓栓塞性肺动脉高压（CTEPH）的 pPH 患者，并定期进行随访。记录基线特征和死亡或肺移植定义的事件。使用 Kaplan-Meier 估计、活表和 Cox 回归分析 HR 的预后价值。
共纳入 206 例 PAH（148 例）和不可手术 CTEPH（58 例）患者。中位 HR 为 82 bpm。HR 低于 82 bpm 的 pPH 患者具有显著更长的总体无事件生存（2409 天 vs.1332 天，p =.000）。如果分别分析 PAH 和 CTEPH，也可以发现这种优势。尽管较低的 HR 与更好的血流动力学和功能分类相关，但即使校正年龄、性别、血流动力学和功能状态，HR 仍然是移植无生存的强烈且独立的预后标志物。
我们表明，诊断时的静息 HR 是 PAH 和 CTEPH 的一个强大且独立的长期预后标志物。是否通过药物降低 HR 会改善 pPH 的预后，需要通过未来的试验进行评估，并高度关注安全性。
