Resting Heart Rate and Chronotropic Response to Exercise: Prognostic Implications in Heart Failure Across the Left Ventricular Ejection Fraction Spectrum.

ABSTRACT

BACKGROUND: We studied the relationship between resting heart rate (HR), chronotropic response to exercise, and clinical outcomes in patients with heart failure (HF) across the spectrum of left ventricle ejection fraction (LVEF). METHODS AND RESULTS: Resting HR and chronotropic index (CIx) were assessed in 718 patients with HF (53 ± 14 years of age, 66% male) referred for exercise testing. Associations with the composite outcome of left ventricular assist device implantation, transplantation, or death (151 events, 4.4 [range 3.0-5.8] years of follow-up) were assessed with the use of Cox models adjusted for age, sex, HF etiology, diabetes, LVEF, beta-blocker use, device therapy, estimated glomerular filtration rate, and peak oxygen uptake. Resting HR was 73 ± 15 beats/min, CIx was 0.60 ± 0.26, LVEF was 34% ± 15%, and 39% had an LVEF ≥40%. Resting HR correlated poorly with CIx (r = 0.08; P = .04) and did not predict (P = .84) chronotropic incompetence (CIx <0.60). Both higher resting HR (per 5 beats/min increase adjusted hazard ratio [HR] -1.05, 95% confidence interval [CI] 1.00-1.11) and CIx (per SD change adjusted HR -0.77, 95% CI 0.62-0.94) were independent prognostic markers. No heterogeneity of effect was noted based on LVEF (P >.05). CONCLUSION: Higher resting HR and lower CIx are both associated with more severe HF, but correlated poorly with each other. They provide independent and additive prognostic information in HF across the LVEF spectrum.