title: Elevated resting heart rate in heart transplant recipients: innocent bystander or adverse prognostic indicator?
abstract: BACKGROUND
  The elevated baseline heart rate (HR) of a heart transplant recipient has previously been considered inconsequential. However, we hypothesized that a resting HR above 100 beats per minute (bpm) may be associated with morbidity and mortality.
  
  
  METHODS
  The U.T.A.H. Cardiac Transplant Program studied patients who received a heart transplant between 2000 and 2011. Outpatient HR values for each patient were averaged during the first year post-transplant. The study cohort was divided into two groups: the tachycardic (TC) (HR > 100 bpm) and the non-TC group (HR ≤ 100 bpm) in which mortality, incidence of rejection, and cardiac allograft vasculopathy were compared.
  
  
  RESULTS
  Three hundred and ten patients were included as follows: 73 in the TC and 237 in the non-TC group. The TC group had a higher risk of a 10-yr all-cause mortality (p = 0.004) and cardiovascular mortality (p = 0.044). After adjustment for donor and recipient characteristics in multivariable logistic regression analysis, the hazard ratio was 3.9, (p = 0.03, CI: 1.2-13.2) and 2.6 (p = 0.02, CI: 1.2-5.5) for cardiovascular mortality and all-cause mortality, respectively.
  
  
  CONCLUSIONS
  Heart transplant recipients with elevated resting HR appear to have higher mortality than those with lower resting HR. Whether pharmacologically lowering the HR would result in better outcomes warrants further investigation.
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: S Blake
authors.initials: SB
authors.lastname: Wachter
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: McCandless
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gilbert
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.affiliation: UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.|Intermountain Heart Institute, Salt Lake City, UT, USA.
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.affiliation: UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.|Intermountain Heart Institute, Salt Lake City, UT, USA.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Reid
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: McKellar
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Nativi-Nicolau
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Abdulfattah
authors.initials: A
authors.lastname: Saidi
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Barney
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: McCreath
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Antigone
authors.initials: A
authors.lastname: Koliopoulou
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Spencer E
authors.initials: SE
authors.lastname: Wright
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
authors.affiliation: School of Medicine, University of Utah, Salt Lake City, UT, USA.|UTAH Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Drakos
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D013610:Tachycardia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality
keywords: all-cause mortality; cardiac allograft vasculopathy; heart rate; heart transplant; multivariable analysis