title: Long-term prognostic value of elevated heart rate one year after heart transplantation.
abstract: BACKGROUND
  Elevated heart rate (HR) is associated with adverse cardiovascular outcome in the general population and in patients with cardiovascular disease. Elevated HR due to graft denervation is often found in heart transplantation (HTx) patients; the effect on graft survival and vasculopathy is unclear. Thus, the aim of this study was to evaluate the role of elevated HR at 12 months post-HTx and its power to predict HTx long-term outcome.
  
  
  METHODS
  We evaluated retrospectively a prospective database of 312 patients undergoing HTx at two centers. HR was registered at 12 months post-HTx. The median HR was used as a cutoff point. Cox regression analysis was performed with variables known to be clinically relevant to mortality and those selected from the univariate analysis.
  
  
  RESULTS
  During a mean follow-up of 5.5 ± 2.8 years there were 58 deaths (19%). Patients with a HR ≥ 90 bpm (median HR) at 12 months had an increased risk for all-cause mortality (Hazard Ratio=2.4, 95% CI 1.2 to 4.5, p=0.009) and mortality related to coronary allograft vasculopathy (CAV) (Hazard Ratio=3.0, 95% CI 1.25-7.14, p=0.01). Multivariate analysis showed that a HR ≥ 90 bpm independently predicted mortality (HR 3.2, 95% CI 1.4-7.1, p=0.004).
  
  
  CONCLUSIONS
  Elevated HR measured at 12 months after HTx is an independent predictor of all-cause mortality in HTx recipients. A HR ≥ 90 bpm identifies a group of patients at high risk of death and CAV-related mortality at mid- to long-term.
authors: Thorax Clinic Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. Electronic address: macastel@clinic.ub.es.
authors: María Ángeles
authors: MÁ
authors: Castel
authors: Eulàlia
authors: E
authors: Roig
authors: José
authors: J
authors: Rios
authors: Carles
authors: C
authors: Tomas
authors: Sonia
authors: S
authors: Mirabet
authors: Montserrat
authors: M
authors: Cardona
authors: Vicens
authors: V
authors: Brossa
authors: Laura
authors: L
authors: López
authors: Luis
authors: L
authors: Vargas
authors: Alessandro
authors: A
authors: Sionis
authors: Isabel
authors: I
authors: Vallejos
authors: Félix
authors: F
authors: Pérez-Villa
mesh_terms: D002423:Cause of Death / Q000639:trends; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000503:physiopathology*; D006085:Graft Survival; D006339:Heart Rate / Q000502:physiology*; D016027:Heart Transplantation / Q000401:mortality*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014184:Transplantation, Homologous
keywords: Allograft vasculopathy; Heart rate; Heart transplantation; Mortality