Wang Chun-Li, Chan Yi-Hsin, Lee Hsin-Fu, Hsiao Fu-Chih, Chu Pao-Hsien
Cardiovascular Division, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center.
College of Medicine, Chang Gung University.
Int Heart J. 2020 Mar 28;61(2):289-294. doi: 10.1536/ihj.19-403. Epub 2020 Mar 14.
High heart rate (HR) is associated with increased risks of adverse outcomes in patients with heart failure. This study aimed to evaluate which measures of HR were associated with all-cause mortality in patients with heart failure and reduced ejection fraction (HFrEF). This study involved 741 HFrEF patients (age 65.1 ± 14.7 years, 71% male) who underwent 24 hour Holter electrocardiogram and resting electrocardiogram within 7 days between 2011 and 2015. We examined the associations of resting, 24 hour, and nighttime HRs with all-cause mortality. Nighttime and 24 hour HRs were determined as the mean HRs between 11:00 p.m. and 7:00 a.m. and over 24 hours, respectively. Nighty patients (12.1%) died during the 2-year follow-up. Resting, nighttime, and 24 hour HRs were significantly associated with all-cause mortality, also after adjusting for conventional risk factors. Resting HR did not remain as an independent factor when 24 hour HR (hazard ratio 1.10, 95% confidence interval 1.04-1.18) was included in the model. Including nighttime HR (hazard ratio 1.11, 95% confidence interval 1.05-1.17) in the model also eliminated 24 hour HR as an independent variable. Compared with the lowest quartile of nighttime HR (< 65 beats/minute), the highest quartile of nighttime HR (> 87 beats/minute) was significantly associated with a higher risk of all-cause mortality (hazard ratio 2.89, 95% CI 1.49-5.60). In conclusion, 24 hour HR and nighttime HR were significantly associated with an increased risk of mortality in patients with HFrEF. Nighttime HR appeared to be more strongly associated with all-cause mortality compared with 24 hour HR.
心率高（HR）与心力衰竭患者不良结局风险增加相关。本研究旨在评估哪些心率指标与射血分数降低的心力衰竭（HFrEF）患者的全因死亡率相关。本研究纳入了741例HFrEF患者（年龄65.1±14.7岁，71%为男性），这些患者在2011年至2015年期间的7天内接受了24小时动态心电图和静息心电图检查。我们研究了静息心率、24小时心率和夜间心率与全因死亡率的关联。夜间心率和24小时心率分别定义为晚上11点至早上7点之间的平均心率和24小时的平均心率。90例患者（12.1%）在2年随访期间死亡。在调整传统危险因素后，静息心率、夜间心率和24小时心率均与全因死亡率显著相关。当模型中纳入24小时心率（风险比1.10，95%置信区间1.04-1.18）时，静息心率不再是独立因素。在模型中纳入夜间心率（风险比1.11，95%置信区间1.05-1.17）也使24小时心率不再是独立变量。与夜间心率最低四分位数（<65次/分钟）相比，夜间心率最高四分位数（>87次/分钟）与全因死亡率风险显著升高相关（风险比2.89，95%CI 1.49-5.60）。总之，24小时心率和夜间心率与HFrEF患者死亡率风险增加显著相关。与24小时心率相比，夜间心率似乎与全因死亡率的关联更强。
