Division of Cardiology, Angiology and Intensive Care, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Kirchfeldstr. 40, 40217, Düsseldorf, Germany.
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Sci Rep. 2024 Nov 25;14(1):29189. doi: 10.1038/s41598-024-78851-z.
Resting heart rate (RHR) has prognostic implications in heart failure with reduced ejection fraction, where ≤ 70 bpm is targeted. Whether a RHR > 70 bpm assessed within clinical practice goes along with elevated cardiovascular risk in implantable cardioverter-defibrillator (ICD) / cardiac resynchronization therapy-defibrillator (CRT-D) recipients remains incompletely understood. A total of 1589 patients (ICD n = 1172 / CRT-D n = 417, median age 65 years, 22.6% female) undergoing ICD/CRT-D implantation or revision in the prospective German DEVICE multicenter registry were analyzed. RHR was assessed via a 12-channel electrocardiogram at enrollment. 1-year outcomes (all-cause mortality, major cardio- and cerebrovascular events (MACCE), all-cause hospital admission) were compared between patients with a RHR ≤ 70 bpm and > 70 bpm. 733 patients (46.1%) showed a RHR > 70 bpm. Median RHR was 63 (interquartile range 59; 68) bpm (≤ 70 bpm group) and 80 (75; 89) bpm (> 70 bpm group). Heart failure with reduced ejection fraction was present in 76.3%, a prior myocardial infarction in 32.4% and non-ischemic heart disease in 44.9%. One-year all-cause mortality was similar between RHR groups (≤ 70 bpm 5.4% vs. > 70 bpm 5.4%, p = 0.96), and subgroup analysis regarding patient characteristics and comorbidities revealed only a significantly higher rate of patients with dual chamber ICD in the > 70 bpm group (0.8% vs. 9.2%, p = 0.003). MACCE (5.9% vs. 6.1%, p = 0.87) and defibrillator shock rates (9.9% vs. 9.8%, p = 1.0) were similar. Higher all-cause hospital admission rates were observed in patients with > 70 bpm RHR (23.1% vs. 29.0%, p = 0.027) driven by non-cardiovascular events (6.0% vs. 11.7%, p = 0.001). In conclusion, in ICD and CRT-D recipients a RHR at admission > 70 bpm may indicate patients at increased risk of all-cause hospital admission but not of other adverse cardiovascular events or death at 1-year follow-up.
静息心率（RHR）在射血分数降低的心力衰竭中有预后意义，目标值为≤70 bpm。在临床实践中评估的 RHR>70 bpm 是否与植入式心脏复律除颤器（ICD）/心脏再同步治疗除颤器（CRT-D）受者的心血管风险升高有关仍不完全清楚。对前瞻性德国 DEVICE 多中心注册研究中接受 ICD/CRT-D 植入或修正的 1589 例患者（ICD n=1172/CRT-D n=417，中位年龄 65 岁，22.6%为女性）进行了分析。通过 12 通道心电图在入组时评估 RHR。比较 RHR≤70 bpm 和>R70 bpm 患者的 1 年结局（全因死亡率、主要心脑血管事件（MACCE）、全因住院）。733 例（46.1%）患者 RHR>70 bpm。中位 RHR 为 63（四分位距 59；68）bpm（≤70 bpm 组）和 80（75；89）bpm（>70 bpm 组）。射血分数降低的心力衰竭占 76.3%，既往心肌梗死占 32.4%，非缺血性心脏病占 44.9%。RHR 组的 1 年全因死亡率相似（RHR≤70 bpm 为 5.4%，RHR>70 bpm 为 5.4%，p=0.96），且关于患者特征和合并症的亚组分析仅显示 RHR>70 bpm 组双腔 ICD 患者的比例显著更高（0.8%比 9.2%，p=0.003）。MACCE（5.9%比 6.1%，p=0.87）和除颤器电击率（9.9%比 9.8%，p=1.0）相似。RHR>70 bpm 患者的全因住院率较高（23.1%比 29.0%，p=0.027），主要由非心血管事件（6.0%比 11.7%，p=0.001）驱动。总之，在 ICD 和 CRT-D 受者中，入院时 RHR>70 bpm 可能提示患者发生全因住院的风险增加，但在 1 年随访时无其他不良心血管事件或死亡的风险增加。
