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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

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Abstract

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.

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Acknowledgments

We thank Dr Harukazu Tsuruta, Department of Medical Informatics, Kitasato University School of Allied Health Sciences, and Dr Keika Hoshi, Kitasato Clinical Research Center, for their outstanding assistance with statistical analysis. This study was supported in part by a grant-in-aid for scientific research from The Vehicle Racing Commemorative Foundation.

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Authors and Affiliations

  1. Department of Cardio-Angiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Shunsuke Ishii, Takayuki Inomata, Yuki Ikeda, Takeru Nabeta, Miwa Iwamoto, Ichiro Watanabe, Takashi Naruke, Hisahito Shinagawa, Toshimi Koitabashi, Mototsugu Nishii, Ichiro Takeuchi & Tohru Izumi

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  1. Shunsuke Ishii
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  2. Takayuki Inomata
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  3. Yuki Ikeda
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  4. Takeru Nabeta
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Correspondence to Shunsuke Ishii.

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Ishii, S., Inomata, T., Ikeda, Y. et al. 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. Heart Vessels 29, 88–96 (2014). https://doi.org/10.1007/s00380-013-0335-0

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