title: Effect of resting heart rate on two-year clinical outcomes of high-risk patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Resting heart rate (HRate) is a modifiable risk factor among patients with cardiovascular disease, including aortic stenosis (AS). However, the effect of resting HRate on clinical outcomes of patients with severe symptomatic AS undergoing transcatheter aortic valve implantation (TAVI) is unknown. Our aim was therefore to assess the effect of resting HRate on clinical outcomes among high-risk patients with symptomatic severe AS in normal sinus rhythm (NSR) undergoing TAVI.
  
  
  RESULTS
  Of 606 consecutive patients undergoing TAVI, 349 (57.6%) with severe AS and a baseline 12-lead electrocardiogram (ECG) showing NSR undergoing TAVI were analysed. Patients were dichotomised into low HRate (LHR; <77 beats per minute [bpm]) and high HRate (HHR; ≥77 bpm) groups. The primary endpoint was all-cause mortality at two years. As compared with baseline LHR, no significant differences in all-cause mortality at two years (adjusted [adj] hazard ratio [HR] 1.23, p=0.40) were observed among patients with baseline HHR. Of 197 patients with available discharge ECGs remaining in NSR, mean HRate significantly increased among LHR patients (∆HRate 8.35, p<0.001) but decreased among HHR patients (∆HRate -4.88, p<0.001). On thirty-day landmark analysis, discharge HHR was significantly associated with two-year all-cause mortality (HR 2.30, 95% CI: 1.16-4.56, p=0.017), but not after extensive adjustment for comorbidities (adj HR 2.01, 95% CI: 0.98-4.09, p=0.056). A significant interaction for two-year mortality (p-interaction 0.021) was observed on landmark analysis for discharge, but not baseline, HHR.
  
  
  CONCLUSIONS
  Baseline and discharge resting HRate were not associated with adverse outcomes after TAVI.
authors.affiliation: Department of Cardiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Crochan J
authors.initials: CJ
authors.lastname: O'Sullivan
authors.forename: Ernest
authors.initials: E
authors.lastname: Spitzer
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.forename: Fabien
authors.initials: F
authors.lastname: Praz
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome