The impact of mean first-year heart rate on outcomes after heart transplantation: does it make a difference?
BACKGROUND
Cardiac denervation following transplantation has a variable effect on heart rate (HR), and the consequence of this is not known. We examined the impact of first-year HR on five-yr outcomes after heart transplant.


METHODS
We evaluated 544 heart transplant recipients from 1994 to 2008. Patients were divided into groups by mean first-year HR: group 1, HR < 90 (mean 85.0 ± 4.3); group 2, 90 ≤ HR < 110 (mean 97.8 ± 4.9); group 3, HR ≥ 110 (mean 111.5 ± 1.8). Endpoints included one-yr freedom from treated rejection, five-yr survival, five-yr freedom from cardiac allograft vasculopathy (CAV), and five-yr freedom from non-fatal major adverse cardiac events (NF-MACE).


RESULTS
One-yr freedom from treated rejection, five-yr survival and freedom from CAV were not significantly different between groups. Five-yr freedom from NF-MACE was significantly lower in group 3 compared with group 2, 69% vs. 91%, p < 0.01, mainly due to higher prevalence of congestive heart failure (CHF) in group 3 over five yr.


CONCLUSIONS
Mean first-year HR does not provide prognostic significance for one-yr freedom from treated rejection, five-yr survival or development of CAV five yr after heart transplant. These results suggest that HR post-heart transplantation does not affect long-term outcomes, but high first-year HRs may be associated with new-onset CHF.
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ankit B
AB
Shah
Jignesh K
JK
Patel
Matthew
M
Rafiei
Ryan P
RP
Morrissey
Michelle M
MM
Kittleson
Jon A
JA
Kobashigawa
D000328:Adult; D064591:Allografts; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival / Q000502:physiology; D006331:Heart Diseases / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D007166:Immunosuppressive Agents
cardiac allograft vasculopathy; heart rate; heart transplantation; outcomes; rejection