Resting heart rate as predictor for left ventricular dysfunction and heart failure: MESA (Multi-Ethnic Study of Atherosclerosis)

Abstract

Objectives: The objective of this study was to investigate the relationship between baseline resting heart rate and incidence of heart failure (HF) and global and regional left ventricular (LV) dysfunction.

Background: The association of resting heart rate to HF and LV function has not been well described in an asymptomatic multi-ethnic population.

Methods: Resting heart rate was measured in participants in the MESA (Multi-Ethnic Study of Atherosclerosis) trial at inclusion. Incident HF was registered (n = 176) during follow-up (median 7 years) in those who underwent cardiac magnetic resonance imaging (n = 5,000). Changes in ejection fraction (ΔEF) and peak circumferential strain (Δεcc) were measured as markers of developing global and regional LV dysfunction in 1,056 participants imaged at baseline and 5 years later. Time to HF (Cox model) and Δεcc and ΔEF (multiple linear regression models) were adjusted for demographics, traditional cardiovascular risk factors, calcium score, LV end-diastolic volume, and mass in addition to resting heart rate.

Results: Cox analysis demonstrated that for 1 beat/min increase in resting heart rate, there was a 4% greater adjusted relative risk for incident HF (hazard ratio: 1.04; 95% CI: 1.02 to 1.06; p < 0.001). Adjusted multiple regression models demonstrated that resting heart rate was positively associated with deteriorating εcc and decrease in EF, even when all coronary heart disease events were excluded from the model.

Conclusions: Elevated resting heart rate was associated with increased risk for incident HF in asymptomatic participants in the MESA trial. Higher heart rate was related to development of regional and global LV dysfunction independent of subclinical atherosclerosis and coronary heart disease. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487).

Keywords: cardiac MRI; coronary heart disease; heart failure; left ventricular dysfunction; myocardial strain; resting heart rate.

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. Cumulative Hazard for Incident CHF Events Split by Baseline Resting Heart Rate Groups (Heart Rate ≤56 is reference)

The heart rate groups are defined as HR: >=56 (blue), HR: 57-62 (red), HR: 63-69 (green) and HR:

Figure 2. End-diastolic mass to end-diastolic volume ratios seen for quartiles of heart rate and categorized by gender at baseline and follow-up

The quartiles are defined as HR: >=56 (group 1), HR: 57-62 (group 2), HR: 63-69 (group 3) and HR: