Department of Epidemiology and Preventive Medicine, CCRE Therapeutics, Monash University/Alfred Hospital, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
London School of Hygiene and Tropical Medicine, London, UK.
Clin Res Cardiol. 2019 Jul;108(7):806-814. doi: 10.1007/s00392-018-1410-4. Epub 2019 Jan 2.
Increased resting heart rate is a risk factor for cardiovascular mortality and morbidity. Mineralocorticoid receptor antagonists (MRAs) have been shown to improve cardiac sympathetic nerve activity, reduce heart rate and attenuate left ventricular remodelling. Whether or not the beneficial effects of MRA are affected by heart rate in heart failure patients with reduced ejection fraction (HFREF) is unclear.
We undertook a secondary analysis of data from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure study to assess if clinical outcomes, as well as the efficacy of eplerenone, varied according to heart rate at baseline.
High resting heart rate of 80 bpm and above predisposed patients to greater risk of all outcomes in the trial, regardless of treatment allocation. The beneficial effects of eplerenone were observed across all categories of heart rate. Eplerenone reduced the risk of primary endpoint, the composite of cardiovascular death and hospitalisation for heart failure, by 30% (aHR 0.70; 95% CI 0.54-0.91) in subjects with heart rate ≥ 80 bpm, and by 48% (aHR 0.52; 95% CI 0.33-0.81) in subjects with heart rate ≤ 60 bpm. Eplerenone also reduced the risks of hospitalisation for heart failure, cardiovascular deaths and all-cause deaths independently of baseline heart rate.
Baseline heart rate appears to be an important predictor of major clinical outcome events in patients with HFREF, as has been previously reported. The benefits of eplerenone were preserved across all categories of baseline heart rate, without observed heterogeneity in the responses.
静息心率增加是心血管死亡率和发病率的一个危险因素。醛固酮受体拮抗剂（MRA）已被证明可改善心脏交感神经活性，降低心率并减轻左心室重构。在射血分数降低的心力衰竭（HFREF）患者中，MRA 的有益效果是否受心率影响尚不清楚。
我们对依普利酮在轻度心力衰竭患者住院和生存研究中的数据进行了二次分析，以评估基线心率是否会影响临床结局以及依普利酮的疗效。
静息心率高 80 bpm 及以上使患者在试验中面临更高的所有结局风险，无论治疗分配如何。依普利酮的有益效果在所有心率类别中均可见。依普利酮使心率≥80 bpm 的患者主要终点（心血管死亡和心力衰竭住院的复合终点）的风险降低 30%（aHR 0.70；95%CI 0.54-0.91），使心率≤60 bpm 的患者主要终点的风险降低 48%（aHR 0.52；95%CI 0.33-0.81）。依普利酮还降低了心力衰竭住院、心血管死亡和全因死亡的风险，与基线心率无关。
正如先前报道的那样，基线心率似乎是 HFREF 患者主要临床结局事件的重要预测指标。依普利酮的益处在所有基线心率类别中均得到保留，且未观察到反应的异质性。
