title: Clinical significance of heart rate during acute decompensated heart failure to predict left ventricular reverse remodeling and prognosis in response to therapies in nonischemic dilated cardiomyopathy.
abstract: Although an increased heart rate (HR) is a strong predictor of poor prognosis in cases of chronic heart failure (HF), the clinical value of HR as a predictor in acute decompensated HF (ADHF) is unclear. Seventy-eight patients with nonischemic dilated cardiomyopathy (NIDCM) with sinus rhythm who were first hospitalized for ADHF from 2002 to 2010 were retrospectively investigated after exclusion of patients with tachycardia-induced cardiomyopathy. The patients were divided into two groups stratified by HR on admission with a median value of 113 beats/min (Group H with HR ≥ 113 beats/min; Group L with HR < 113 beats/min). Despite similar backgrounds, including pharmacotherapy for HF, HR changes responding to titration of β-blocker (BB) therapy and myocardial interstitial fibrosis, left ventricular (LV) ejection fractions improved more significantly 1 year later in Group H than in Group L (57 % ± 11 % vs. 46 % ± 12 %, P < 0.001). Cardiac event-free survival rates were also significantly improved in Group H (P = 0.038). Multiple regression analysis revealed that only the peak HR on admission was an independent predictor of LV reverse remodeling (LVRR) 1 year later (β = 0.396, P = 0.005). High HR on first admission for ADHF is a strong predictor of LVRR, with a better prognosis in the event of NIDCM in response to optimal pharmacotherapy, independent of pre-existing myocardial damage and subsequent HR reduction by BB therapy.
authors.affiliation: Department of Cardio-Angiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan, sishii@med.kitasato-u.ac.jp.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Ishii
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inomata
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Takeru
authors.initials: T
authors.lastname: Nabeta
authors.forename: Miwa
authors.initials: M
authors.lastname: Iwamoto
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Naruke
authors.forename: Hisahito
authors.initials: H
authors.lastname: Shinagawa
authors.forename: Toshimi
authors.initials: T
authors.lastname: Koitabashi
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Nishii
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takeuchi
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
mesh_terms: D000328:Adult; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis; D010343:Patient Admission; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D002317:Cardiovascular Agents