Resting Heart Rate and Heart Rate Reserve in Advanced Heart Failure Have Distinct Pathophysiologic Correlates and Prognostic Impact A Prospective Pilot Study
Resting Heart Rate and Heart Rate Reserve in Advanced Heart Failure Have Distinct Pathophysiologic Correlates and Prognostic Impact A Prospective Pilot Study
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DOI：
10.1016/j.jchf.2013.03.008
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发表时间：
2013-06-01
影响因子：
13
通讯作者：
Melenovsky, Vojtech
中科院分区：
文献类型：
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作者：
Benes, Jan;Kotrc, Martin;Melenovsky, Vojtech
目的本研究的目的是比较心力衰竭（HF）患者静息心率（HR）和变时性功能不全的临床和生物标志物相关性的预后影响。背景HF患者HR异常的机制和潜在的病理生理影响尚不完全清楚。方法在一项前瞻性初步研究中，81例晚期收缩期HF患者（97%接受β受体阻滞剂）和25岁，性别，和体型匹配的健康对照组进行最大心肺运动试验，并取样神经激素和生物标志物。三分之一的HF患者符合变时性功能不全的标准。静息HR和HR储备（HRR，变时性反应的测量）彼此不相关，并且与不同的生物标志物特征相关。静息HR与心肌应激增加（B型利钠肽[BNP]：r = 0.26; A型利钠肽原：r = 0.24; N末端-proBNP：r = 0.32）和炎症（白细胞计数：r = 0.28;高敏C反应蛋白测定：r = 0.25）相关。相反，HRR与HF的神经体液反应相关（和肽素：r = -0.33;去甲肾上腺素：r = -0.29），但与利钠肽或hs-肌钙蛋白I反映的心肌细胞应激或损伤无关。最低变时性功能不全四分位数（HRR 67 beats/min）或更低HRR的患者，这两个标志物提供了额外的预后信息。结论静息HR增加和变时性功能不全可能反映不同的病理生理过程，提供增量预后信息，并代表不同的治疗目标。(c)2013年美国心脏病学会基金会
Objectives The purpose of this study was to compare the prognostic impact of clinical and biomarker correlates of resting heart rate (HR) and chronotropic incompetence in heart failure (HF) patients.Background The mechanisms and underlying pathophysiological influences of HR abnormalities in HF are incompletely understood.Methods In a prospective pilot study, 81 patients with advanced systolic HF (97% were receiving beta-blockers) and 25 age-, sex-, and body-size matched healthy controls underwent maximal cardiopulmonary exercise testing with sampling of neurohormones and biomarkers.Results Two-thirds of HF patients met criteria for chronotropic incompetence. Resting HR and HR reserve (HRR, a measure of chronotropic response) were not correlated with each other and were associated with distinct biomarker profiles. Resting HR correlated with increased myocardial stress (B-type natriuretic peptide [BNP]: r = 0.26; pro-A-type natriuretic peptide: r = 0.24; N-terminal-proBNP: r = 0.32) and inflammation (leukocyte count: r = 0.28; high-sensitivity C-reactive protein assay: r = 0.25). In contrast, HRR correlated with the neurohumoral response to HF (copeptin: r = -0.33; norepinephrine: r = -0.29) but not with myocyte stress or injury reflected by natriuretic peptides or hs-troponin I. Patients in the lowest chronotropic incompetence quartile (HRR 67 beats/min) or lower HRR, with bothmarkers providing additive prognostic information.Conclusions Increased resting HR and chronotropic incompetence may reflect different pathophysiological processes, provide incremental prognostic information, and represent distinct therapeutic targets. (c) 2013 by the American College of Cardiology Foundation