Usefulness of heart rate as an independent predictor for survival after heart transplantation.
It was unclear whether increased heart rate (HR) increased long-term mortality after heart transplantation (HT). The aim of this study was to evaluate whether HR predicted survival after HT. A retrospective analysis of patients who underwent HT at our institution was performed. Ethnicity, gender, date of birth, age at transplantation, length of follow-up after transplantation, cardiac rhythm within 3 months after transplantation, age at death, reason for transplantation, cause of death, and baseline medications after transplantation were recorded. Continuous variables, such as HR, blood pressure, cardiac ejection fraction, presence of allograft vasculopathy, and serum creatinine, were recorded at <3 months, 6 months, and 1 year after HT, then annually to 10 years after HT. Seventy-eight patients with a mean age of 50 +/- 13 years were identified. Mean survival was 8.5 +/- 6.5 years. Of 78 patients, 32 patients had an HR <or=90 beats/min, and 46 patients had an HR >90 beats/min within 3 months after HT. There was a mean decrease in HR of 6 beats/min during 10 years (p <0.03). Multivariate survival analysis showed that HR >90 beats/min was a significant predictor of early mortality (hazard ratio 2.8, 95% confidence interval 1.5 to 5.1, p <0.0013). Patients with a net increase in HR during 10 years had an increased risk of death compared with patients with no change or a net decrease in HR (hazard ratio 4.7, 95% confidence interval 1.9 to 12.0, p <0.002). No significant differences in cause of death between patients with an HR <or=90 or >90 beats/min existed. In conclusion, HT patients with an HR >90 beats/min within the first 3 months after HT were 2.8 times more likely to die than patients with an HR <or=90 beats/min. Patients with a net increase in HR were 4.7 times more likely to die than those whose HR did not change or decreased over time.
Anand
Rishi G
RG
Department of Cardiology, Division of Electrophysiology, University of Maryland Medical System, Baltimore, Maryland, USA.
Reddy
Madhavi T
MT
Yau
C L
CL
Myers
Leann
L
Amin
Rohit R
RR
Stahls
Paul F
PF
Dumas
Debbie
D
Frohlich
Edward D
ED
Ventura
Hector O
HO
D000328:Adult; D000367:Age Factors; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012737:Sex Factors; D016019:Survival Analysis; D013997:Time Factors