Sinus Tachycardia During The First Year after Heart Transplantation is Associated with Worse Long-Term Outcomes

摘要

BackgroundElevated heart rate (HR) is an important risk factor for adverse outcomes in healthy people and across the entire spectrum of cardiovascular diseases. The effect of an elevated heart rate on patients post heart transplantation (HTx) though has not been well established. ObjectiveThe aim of this study was to assess the predictors and prognostic significance of elevated HR after HTx. MethodsA total cohort of 394 patients who underwent HTx at two academic medical centers between 2005-2016 were divided into two groups based on HR at 1 year after HTx: 1) HR≥95 beats/min (bpm; n=162 [41%]) and 2) HR<95bpm (n=232 [59%]). Median follow-up was 6.6 (25%-75% IQR 2.2 – 7.5) years. ResultsHR≥95?bpm at 1-year post-HTx was associated with younger donor age (OR 1.1; CI 1.0-2.3,P=0.05), whereas HR<95 bpm was associated with heavy alcohol use in the donor (OR 0.43; CI 0.17-0.61;P=.04) and African-American recipients race (OR 0.40; 95% CI 0.19-0.85;P=0.02). Left ventricular diastolic dimension (4.3±0.5cm vs. 4.5±0.5cm, p < 0.001), mass (158±44 mg vs. 189±59 mg, p<0.001) and ejection fraction (56±5.2% vs 59±9.1%, p=0.03) were lower in HR≥95 group at last follow up echo. HR≥95?bpm was associated with the development of cardiac allograft vasculopathy (CAV) [] and increased post-HTx mortality [] and was independent predicter of CAV (HR 2.7, 95% CI 1.4–5.5, p=0.005) and mortality (HR 3.9, 95% CI 1.4-7.7, p=0.02) after Cox proportional hazard analysis. ConclusionHR≥95 is associated with long term decrease in LV mass and systolic function, development of CAV and reduced survival. Studies investigating the effect of medical HR reduction on post-HTx outcomes are warranted.