Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Instituto de Investivación Sanitaria INCLIVA, Valencia, Spain.
Scand Cardiovasc J. 2024 Dec;58(1):2386977. doi: 10.1080/14017431.2024.2386977. Epub 2024 Aug 8.
The clinical impact of heart rate (HR) in heart failure with preserved ejection fraction (HFpEF) is a matter of debate. Among those with HFpEF, chronotropic incompetence (CI) has emerged as a pathophysiological mechanism linked to the severity of the disease. In this study, we sought to evaluate whether admission heart rate in acute heart failure differs along left ventricular ejection fraction (LVEF).
We included retrospectively 3,712 consecutive patients admitted for acute heart failure (AHF) in the Cardiology department of a third level center. HR values were assessed at presentation. LVEF was assessed by transthoracic echocardiogram during the index admission and stratified into four categories: reduced ejection fraction (40%), mildly reduced ejection fraction (41-49%), preserved ejection fraction (50-64%) and supranormal ejection fraction (65%). The association between HR and LVEF was assessed by multivariate linear and multinomial regression analyses.
The mean age of the sample was 73,9 ± 11.3 years, 1,734 (47,4%) were women, and 1,214 (33,2%), 570 (15,6%), 1,229 (33,6%) and 648 (17,7%) patients showed LVEF 40%, 41-49%, 50-64%, and ≥65% respectively. The median HR at admission was 95 (IQR 78-120) beats per minute and 1,653 were on atrial fibrillation (45.2%). There was an inverse relationship between HR at admission and LVEF. Lower HR was significantly associated with a higher LVEF in the whole sample ( < 0,001). This inverse relationship was found in sinus rhythm but not in patients with atrial fibrillation.
HR at admission for AHF is a predictor of LVEF but only in patients with sinus rhythm.
心率（HR）在射血分数保留的心力衰竭（HFpEF）中的临床意义仍存在争议。在 HFpEF 患者中，变时性功能不全（CI）已成为与疾病严重程度相关的病理生理机制。本研究旨在评估急性心力衰竭患者的入院心率是否因左心室射血分数（LVEF）不同而有所差异。
我们回顾性纳入了在三级中心心内科因急性心力衰竭（AHF）入院的 3712 例连续患者。在入院时评估 HR 值。通过经胸超声心动图在指数入院期间评估 LVEF，并分为以下四类：射血分数降低（40%）、轻度射血分数降低（41-49%）、射血分数保留（50-64%）和射血分数超常（65%）。通过多元线性和多项回归分析评估 HR 与 LVEF 之间的相关性。
样本的平均年龄为 73.9±11.3 岁，1734 例（47.4%）为女性，1214 例（33.2%）、570 例（15.6%）、1229 例（33.6%）和 648 例（17.7%）患者的 LVEF 分别为 40%、41-49%、50-64%和≥65%。入院时的中位数 HR 为 95（IQR 78-120）次/分钟，1653 例（45.2%）为心房颤动。入院时的 HR 与 LVEF 呈负相关。在整个样本中，较低的 HR 与较高的 LVEF 显著相关（ < 0.001）。这种负相关关系在窦性心律中存在，但在心房颤动患者中不存在。
急性心力衰竭患者的入院心率是 LVEF 的预测指标，但仅在窦性心律患者中如此。
