title: Effect of Heart Rate and Use of Beta Blockers on Mortality After Heart Transplantation.
abstract: Heart transplantation (HT) recipients may have tachycardia secondary to cardiac denervation. As higher heart rate predicts worse outcomes in cardiovascular disease, we hypothesized that tachycardia and nonuse of β blockers are associated with increased mortality after HT. All patients who underwent HT at our institution from 1987 to 2010 were included. The association of heart rate 3 months after HT and β-blocker use during follow-up to mortality was assessed using Kaplan-Meier and multivariate Cox proportional hazards regression analyses adjusting for clinically relevant baseline variables. From 1987 to 2010, there were 493 HT. After excluding 29 who died within 3 months and 3 with follow-up <3 months, 461 HT recipients (50 ± 2 years; 20% women) were included. Over a follow-up of 12 ± 7 years, selected important univariate predictors of post-HT mortality were older age, male gender, higher body mass index, ischemic cardiomyopathy, longer post-HT intensive care unit stay, and hospitalization and at 3 months, increased mean pulmonary artery pressure, right atrial pressure and pulmonary capillary occlusion pressure, higher heart rate, and nonuse of β blockers during follow-up. In multivariate analysis, older ager, longer hospitalization, higher mean pulmonary artery pressure, higher heart rate at 3 months (hazard ratio 1.02 per beat, 95% confidence interval 1.008 to 1.035, p = 0.02) and nonuse of β blockers (hazard ratio 1.43, 95% confidence interval 1.002 to 2.031, p <0.05) were associated with mortality. In conclusion, in a large single-center cohort of HT recipients, higher heart rate and nonuse of β blockers were independently associated with higher mortality.
authors.affiliation: Department of Cardiovascular Diseases, Catholic University of Leuven, Leuven, Belgium. Electronic address: agnieszka.ciarka@uzleuven.be.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Ciarka
authors.affiliation: Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: Department of Cardiovascular Diseases, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Van Cleemput
authors.affiliation: Department of Cardiovascular Diseases, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Gabor
authors.initials: G
authors.lastname: Voros
authors.affiliation: Department of Cardiovascular Diseases, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Droogne
authors.affiliation: Department of Cardiovascular Diseases, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Vanhaecke
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D001793:Blood Preservation; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate; D016027:Heart Transplantation; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000601:surgery*; D016016:Proportional Hazards Models; D065840:Protective Factors; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists