title: Heart rate and cardiac allograft vasculopathy in heart transplant recipients.
abstract: BACKGROUND
  Elevated heart rate (HR) has been indicated as risk factor for cardiovascular disease. Experimental data support a role of HR in the progression and severity of atherosclerotic lesions. Sinus tachycardia is common in heart transplant patients due to the lack of autonomic control. This study assessed the role of HR in the development of cardiac allograft vasculopathy (CAV) in heart transplant recipients.
  
  
  METHODS
  Data from 244 allograft recipients were analyzed. Known factors affecting CAV and mean HR obtained from 24-hour recordings at 1 year (dichotomized at ≥90 beats/min) were tested in univariate and multivariable Cox analysis.
  
  
  RESULTS
  During a median of 96 months, 60 patients (25%) experienced CAV. Surprisingly, HR < 90 but not ≥90 beats/min was significantly associated with an increased CAV development. Univariate analysis showed several predictors were associated with the end point; however, at multivariable analysis, only donor's age, chronic renal failure, and left ventricular end-diastolic wall thickness were significant predictors of CAV, with hazard ratios of 1.02 (95% confidence interval, 1.00-1.04), 1.90 (1.13-3.21), and 1.11 (1.00-1.22), respectively. A highly statistically significant difference in donor's age was found among patients with mean heart rate ≥90 or <90 beats/min (30 ± 13 vs 40 ± 14 years, p < 0.0001).
  
  
  CONCLUSIONS
  In the denervated heart, sinus tachycardia is not a risk factor for coronary atherosclerosis. HR in heart transplant recipients reflects "intrinsic heart rate" and is a simple epiphenomenon of the donor's age.
authors.affiliation: Divisione di Cardiologia, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, (Pavia), Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Olmetti
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Pinna
authors.forename: Roberto
authors.initials: R
authors.lastname: Maestri
authors.forename: Andrea
authors.initials: A
authors.lastname: D'Armini
authors.forename: Carlo
authors.initials: C
authors.lastname: Pellegrini
authors.forename: Mario
authors.initials: M
authors.lastname: Viganò
authors.forename: Daniele
authors.initials: D
authors.lastname: Lilleri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gerna
authors.forename: Oreste
authors.initials: O
authors.lastname: Febo
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: La Rovere
mesh_terms: D000328:Adult; D000367:Age Factors; D003324:Coronary Artery Disease / Q000453:epidemiology*; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000503:physiopathology; D014184:Transplantation, Homologous; D014652:Vascular Diseases / Q000453:epidemiology*