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

• Published in: Heart and vessels Vol. 29; no. 1; pp. 88 - 96
• Main Authors: Ishii, Shunsuke, Inomata, Takayuki, Ikeda, Yuki, Nabeta, Takeru, Iwamoto, Miwa, Watanabe, Ichiro, Naruke, Takashi, Shinagawa, Hisahito, Koitabashi, Toshimi, Nishii, Mototsugu, Takeuchi, Ichiro, Izumi, Tohru
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.01.2014; Springer Nature B.V
• Subjects: Adult; Aged; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Cardiomyopathy, Dilated - diagnosis; Cardiomyopathy, Dilated - drug therapy; Cardiomyopathy, Dilated - etiology; Cardiomyopathy, Dilated - physiopathology; Cardiovascular Agents - therapeutic use; Disease-Free Survival; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - etiology; Heart Failure - physiopathology; Heart rate; Heart Rate - drug effects; Humans; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; Original Article; Patient Admission; Retrospective Studies; Risk Factors; Stroke Volume - drug effects; Time Factors; Treatment Outcome; Vascular Surgery; Ventricular Function, Left - drug effects; Ventricular Remodeling - drug effects; Heart rate; Acute decompensated heart failure; Prognosis; Left ventricular reverse remodeling
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-013-0335-0

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.