تغییرات موقتی در ضربان قلب در نارسایی قلبی و بیماری های قلبی
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSIONS
References
ABSTRACT
Introduction The prognostic significance of temporal changes in resting heart rate in young adults for premature heart failure and cardiovascular disease is unclear. We investigated the association between temporal changes in resting heart rate in young adults and early adult risk factors, subsequent cardiac function, and the risk of heart failure and cardiovascular by middle age. Materials and Methods We examined 4343 Coronary Artery Risk Development in Young Adults (CARDIA) study participants (mean (SD) age was 29.9 (3.6) years at the CARDIA Year-5 exam [1990-1991], 49% of participants were men, and 45% were African-American). Adjusted linear regression models were used to assess the association between temporal changes in resting heart rate, early life cardiovascular disease risk factors, and mid-life cardiac function. Cox proportional hazard regression models were used to relate temporal changes in resting heart rate to heart failure and cardiovascular disease. Outcomes were followed up until August 31, 2017. Results Higher alcohol consumption (β=0.03, p<0.001), lower physical activity (β=0.002,p=001), smoking (β=1.58, p<0.001), men (p<0.001), African-Americans (p<0.001), impaired left ventricular relaxation (e´,β=-0.13, p=0.002), and worse diastolic function (E/e´,β=0.1, p=0.01) were associated with longitudinal increases in resting heart rate. We observed 268 cardiovascular disease and 74 heart failure events over a median of 26 years. In Cox models, baseline and temporal changes in resting heart rate were associated with higher risk of heart failure (hazard ratio (HR)=1.37 95% confidence interval (CI) [1.05-1.79] and HR=1.38 95%CI [1.02-1.86]) and a higher risk cardiovascular disease (HR=1.23 95%CI [1.07-1.42] and HR=1.23 95%CI [1.05-1.44]). Conclusions Baseline and temporal changes in resting heart rate in young adults were associated with incident heart failure and cardiovascular disease by mid-life. Contributory factors were associations between temporal increases in resting heart rate and early adult risk factors and subsequent cardiac dysfunction.
INTRODUCTION
Resting heart rate is an easily measured parameter that is routinely obtained in clinical practice and research settings. In the general population, higher resting heart rate at the time of risk assessment has been associated with an increased risk of cardiovascular disease, including heart failure. A single time-point resting heart rate may however proffer limited clinical utility for risk assessment in the general population, because asymptomatic individuals in the community frequently present within a physiologic range of resting heart rate. Long-term changes in resting heart rate from baseline values may thus provide a more reliable target for disease surveillance or risk stratification. Few studies have assessed the impact of temporal changes in resting heart rate on cardiovascular health and these prior studies have focused on populations with either prevalent cardiovascular disease or those in mid-to-late adulthood.