심부전 환자에서 안정시 심박수의 의의: 전북지역 만성 심부전 등록연구 = Significance of Resting Heart Rate in Chronic Heart Failure: Data from Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) Registry

다국어 초록 (Multilingual Abstract)

Background: Chronic heart failure (HF) is a leading cause of morbidity and mortality in industrialized countries. Raised resting heart rate (HR) is a marker of cardiovascular risk in general population, as well as in patients with hypertension and coronary artery disease. We studied the association between HR and cardiovascular events in patients with Cardiac Insufficiency of Various Origin in Jeonbuk (CION-J) registry. Methods: CION-J registry was a multicenter, prospective database for chronic HF. From January 2010 to December 2010, 356 HF patients who clinically stabilized at least 2 weeks were analyzed. According to resting HR, the patients divided into the tertile (lower tertile < 70/min, n = 129; middle tertile 70–80/min, n = 114; upper tertile > 80/min, n = 113). Clinical outcomes during 6-month period were compared by resting HR. Results: Patients with upper tertile revealed higher New York Heart Association (NYHA) class than in those with lower tertile. From the lower to the upper tertile, the incidence of composite events of death, non-fatal myocardial infarction,ischemic stroke, and hospitalization for HF were increased(3.1%, 4.4%, 16.8%, respectively; p < 0.001). Patients with upper tertile had a higher predictive value for the incidence of death (hazard ratio, 5.8; p = 0.036) and hospitalization for HF (hazard ratio, 6.4; p < 0.001) than in those with middle and lower tertile. In multivariate analysis, NYHA class III/IV, resting HR > 80/min, and ejection fraction < 35% were independent predictors of adverse events. Conclusions: High resting HR (>80/min) is a prognostic factor in chronic HF. Optimal treatment to reduce HR should be emphasized to improve prognosis of HF.

참고문헌 (Reference)

1 유병수, "심부전의 약물 치료" 대한내과학회 81 (81): 716-719, 2011

2 Haber HL, "Why do patients with congestive heart failure tolerate the initiation of beta-blocker therapy?" 88 (88): 1610-1619, 1993

3 Gullestad L, "What resting heart rate should one aim for when treating patients with heart failure with a beta-blocker? Experiences from the Metoprolol Controlled Release/ Extended Release Randomized Intervention Trial in Chronic Heart Failure(MERIT-HF)" 45 : 252-259, 2005

4 Unverferth DV, "The role of subendocardial ischemia in perpetuating myocardial failure in patients with nonischemic congestive cardiomyopathy" 105 : 176-179, 1983

5 Cleland JG, "The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis" 24 : 442-463, 2003

6 Tsutsui H, "JCARE-GENERAL Investigators. Characteristics and outcomes of patients with heart failure in general practices and hospitals" 71 : 449-454, 2007

7 Gillman MW, "Influence of heart rate on mortality among persons with hypertension : the Framingham Study" 125 : 1148-1154, 1993

8 Hjalmarson A, "Influence of heart rate on mortality after acute myocardial infarction" 65 : 547-553, 1990

9 Kolloch R, "Impact of resting heart rate on outcomes in hypertensive patients with coronary artery disease : findings from the International Verapamil-SR/trandolapril Study(INVEST)" 29 : 1327-1334, 2008

10 Perski A, "Heart rate correlates with severity of coronary atherosclerosis in young postinfarction patients" 116 (116): 1369-1373, 1988

11 Bohm M, "Heart rate as a risk factor in chronic heart failure(SHIFT) : the association between heart rate and outcomes in a randomised placebo-controlled trial" 376 : 886-894, 2010

12 Fox K, "Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction(BEAUTIFUL) : a subgroup analysis of a randomised controlled trial" 372 : 817-821, 2008

13 Kannel WB, "Heart rate and cardiovascular mortality: the Framingham Study" 113 : 1489-1494, 1987

14 Lechat P, "Heart rate and cardiac rhythm relationships with bisoprolol benefit in chronic heart failure in CIBIS II Trial" 103 : 1428-1433, 2001

15 Jessup M, "Heart failure" 348 : 2007-2001,

16 Lindenfeld J, "HFSA 2010 comprehensive heart failure practice guideline" 16 : 475-539, 2010

17 Kim TS, "From Hypertension to Heart Failure" 15 : 1-11, 2009

18 Kelly RP, "Effective arterial elastance as index of arterial vascular load in humans" 86 : 513-521, 1992

19 최동주, "Characteristics, Outcomes and Predictors of Long-Term Mortality for Patients Hospitalized for Acute Heart Failure: A Report From the Korean Heart Failure Registry" 대한심장학회 41 (41): 363-371, 2011

20 Adams KF Jr, "Characteristics and outcomes of patients hospitalized for heart failure in the United States : rationale, design, and preliminary observations from the first 100, 000 cases in the Acute Decompensated Heart Failure National Registry(ADHERE)" 149 : 209-216, 2005

21 Chae SC, "Angiotensin receptor blockers in high risk cardiovascular diseases" 14 : 1-3, 2008

22 Flannery G, "Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers" 101 : 865-869, 2008

23 Kaye DM, "Adverse consequences of high sympathetic nervous activity in the failing human heart" 26 : 1257-1263, 1995

24 Mann DL, "Adrenergic effects on the biology of the adult mammalian cardiocyte" 85 : 790-804, 1992