Lancellotti Patrizio, Ancion Arnaud, Magne Julien, Ferro Giovanni, Piérard Luc A
University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium.
University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium.
Int J Cardiol. 2015 Mar 1;182:426-30. doi: 10.1016/j.ijcard.2015.01.027. Epub 2015 Jan 10.
Elevated resting heart rate is associated with worse outcomes in chronic heart failure (HF) but little is known about its prognostic impact in acute setting. The main aim of the present study was to examine the relationship between resting heart rate obtained 24-36h after admission for acute non-arrhythmic HF and in-hospital mortality.
We examined the association of heart rate with in-hospital mortality in a cohort of 712 patients admitted for acute HF. None of the patients had significant arrhythmias, required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Forty patients (5.6%) died during the hospital stay. Those patients were significantly older (78±9 vs. 72±12years; p=0.0021), had higher heart rate (92±22 vs. 78±18bpm; p<0.0001), NT pro-BNP (p=0.0005), creatinine (p=0.023), were often diabetics (p=0.026) and had lower systolic and diastolic blood pressures (p<0.05). There was a significant graded relationship between the increase in mortality rate and tertile of heart rate (p<0.01). With multivariable analysis, age (p=0.037), heart rate (p<0.0001), diastolic blood pressure (p<0.001), prior ischemic heart disease (p=0.02) and creatinine (p=0.019) emerged as independent predictors of in-hospital mortality. After adjusting for predictors of poor prognosis, patients in the highest heart rate tertile had worst outcomes when compared with those in the lowest heart rate group (p=0.007).
Higher heart rate 24-36h after admission for acute non-arrhythmic HF is associated with increased risk of in-hospital mortality. Early targeting of elevated heart rate might represent a complementary therapeutic challenge.
静息心率升高与慢性心力衰竭（HF）的不良预后相关，但对于其在急性情况下的预后影响知之甚少。本研究的主要目的是探讨急性非心律失常性HF入院后24 - 36小时测得的静息心率与院内死亡率之间的关系。
我们在712例因急性HF入院的患者队列中研究了心率与院内死亡率的关联。所有患者均无明显心律失常、无需有创通气，也未出现急性冠状动脉综合征或原发性瓣膜病。40例患者（5.6%）在住院期间死亡。这些患者年龄显著更大（78±9岁 vs. 72±12岁；p = 0.0021），心率更高（92±22次/分 vs. 78±18次/分；p < 0.0001），N末端脑钠肽前体（NT pro - BNP）水平更高（p = 0.0005），肌酐水平更高（p = 0.023），糖尿病患者比例更高（p = 0.026），收缩压和舒张压更低（p < 0.05）。死亡率增加与心率三分位数之间存在显著的分级关系（p < 0.01）。多变量分析显示，年龄（p = 0.037）、心率（p < 0.0001）、舒张压（p < 0.001）、既往缺血性心脏病（p = 0.02）和肌酐（p = 0.019）是院内死亡率的独立预测因素。在对预后不良的预测因素进行校正后，与最低心率组相比，最高心率三分位数组的患者预后最差（p = 0.007）。
急性非心律失常性HF入院后24 - 36小时心率较高与院内死亡风险增加相关。早期针对升高的心率进行干预可能是一项补充性的治疗挑战。
