MESA Substudy Links Heart Failure With Elevated Resting Heart Rate

A substudy of the Multi-Ethnic Study of Atherosclerosis (MESA) suggests that elevated resting heart rate is associated with regional and global left-ventricular dysfunction and an increased risk for incident heart failure in asymptomatic individuals.

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The substudy, which was published in the Journal of the American College of Cardiology, measured changes in ejection fraction and peak circumferential strain as markers of developing global and regional left-ventricular dysfunction in 1,056 participants who underwent cardiac MRI at baseline and five years later. The endpoint of was a composite of probable and definite heart failure. A diagnosis of probable heart failure required a physician’s diagnosis and treatment for heart failure in addition to clinical signs and symptoms.

Through a median seven years of follow up, 176 heart failure events occurred, of which 140 were definite and 36 were probable. Adjusted analyses of the participants’ resting heart rate as a continuous variable indicated that for every 1 beat per minute increase in heart rate, the risk of incident heart failure increased by 4 percent (p <0.001).

Results also showed that increased resting heart rate was associated with reduced regional left-ventricular (LV) function (p < 0.001) and reduced global LV function (p < 0.001). Repeated analyses that excluded participants who had coronary heart disease events found statistically significant associations between resting heart rate and changes in ejection fraction and peak circumferential strain, suggesting that increased resting heart rate is an independent predictor of regional and global LV dysfunction.

According to the study authors, “the present study demonstrates that in a large multi-ethnic cohort without symptoms of cardiovascular disease at enrollment, elevated heart rate was strongly associated with the development of regional and global LV dysfunction, as well as incident heart failure.” They also note that these findings were independent of demographic confounders, established cardiovascular risk factors, and markers of subclinical atherosclerosis, as well as LV structure and function at inclusion.

MESA is an ongoing prospective, observational clinical trial sponsored by the National Heart, Lung, and Blood Institute evaluating the characteristics of subclinical cardiovascular disease that predict clinically overt cardiovascular disease in a diverse and representative population-based sample of 6,814 men and women aged 45 to 84. All participants had their resting heart rate measured at inclusion in the study.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: National Heart, Lung, and Blood Institute (U.S.), Atherosclerosis, Heart Failure, Risk Factors, Heart Rate

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