심부전 환자에서 안정시 심박수의 의의: 전북지역 만성 심부전 등록연구
Significance of Resting Heart Rate in Chronic Heart Failure: Data from Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) Registry
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Background: Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry. Methods: CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile < 70/min, n = 129; middle tertile 70–80/min, n = 114; upper tertile > 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR. Results: Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction,ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p < 0.001). Patients with upper tertile had a higher predictive value for the incidence of death (hazard ratio, 5.8; p = 0.036) and hospitalization for HF (hazard ratio, 6.4; p < 0.001) than in those with middle and lower tertile. In multivariate analysis, NYHA class III/IV, resting HR > 80/min, and ejection fraction < 35% were independent predictors of adverse events. Conclusions: High resting HR (>80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF.
Abstract
Background: Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry. Methods: CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile < 70/min, n = 129; middle tertile 70–80/min, n = 114; upper tertile > 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR. Results: Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction,ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p < 0.001). Patients with upper tertile had a higher predictive value for the incidence of death (hazard ratio, 5.8; p = 0.036) and hospitalization for HF (hazard ratio, 6.4; p < 0.001) than in those with middle and lower tertile. In multivariate analysis, NYHA class III/IV, resting HR > 80/min, and ejection fraction < 35% were independent predictors of adverse events. Conclusions: High resting HR (>80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF.
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