The prognostic association between resting heart rate and cardiac death--myocardial perfusion defects as a potential mechanism
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Published on: August 17, 2022
Brent A Williams1, Michael E Merhige
1Heart Center of Niagara, Niagara Falls, NY, USA. bawilliams2@geisinger.edu
Insights
Elevated resting heart rate (RHR) independently predicts cardiac death in patients with coronary artery disease (CAD). Myocardial perfusion defects do not fully explain this association, highlighting RHR as a critical risk factor.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- Elevated resting heart rate (RHR) is a known risk factor for cardiac events.
- Lowering RHR may reduce cardiac risk in patients with coronary artery disease (CAD).
Purpose of the Study:
- To determine if myocardial perfusion defects explain the link between RHR and cardiac death.
- Investigate the association in patients undergoing myocardial perfusion imaging (MPI).
Main Methods:
- Retrospective cohort study of 3708 patients with known or suspected CAD.
- Positron emission tomography MPI used to quantify myocardial perfusion defects.
- RHR measured by ECG; cardiac death data from National Death Index; analyses stratified by beta-blocker use.
Main Results:
- RHR associated with myocardial perfusion defects, stronger in beta-blocker users.
- RHR independently predicted cardiac death in adjusted models, irrespective of perfusion defect size.
- Hazard ratio for cardiac death was 2.6 (RHR ≥ 80 bpm vs. RHR < 60 bpm) among beta-blocker users.
Conclusions:
- Resting heart rate is an independent predictor of cardiac death.
- Myocardial perfusion defects do not significantly explain the association between RHR and cardiac death.
- RHR remains a critical risk factor for adverse cardiac outcomes.
Objective:
Elevated resting heart rate (RHR) is a robust risk factor for cardiac events, and recent clinical trial evidence suggests lowering RHR may reduce cardiac risk among individuals with elevated RHR and known coronary artery disease (CAD). This study sought to elucidate the extent to which myocardial perfusion defects explain the association between RHR and cardiac death among individuals with known or suspected CAD undergoing myocardial perfusion imaging (MPI).
Methods:
This retrospective cohort study included 3708 individuals with known or suspected CAD who underwent clinically indicated MPI with positron emission tomography (PET MPI). Stress, rest, and stress-induced myocardial perfusion defect sizes were measured objectively by automated computer software as percent of left ventricular myocardium hypoperfused. RHR was measured by electrocardiography prior to rest PET MPI. Cardiac and non-cardiac death information was obtained through the National Death Index. All analyses were stratified by beta blocker (BB) use.
Results:
RHR was consistently associated with the presence of significant myocardial perfusion defects, though associations were stronger among BB than non-BB users. Among BB users, RHR was strongly associated with an increased risk of cardiac death in adjusted models before (hazard ratio [HR] = 2.6 comparing RHR ≥ 80 bpm vs. RHR<60, p<0.05) and after (HR = 2.4, p<0.05) including stress myocardial perfusion defect size in the model. Results were similarly strong among non-BB users.
Conclusions:
Resting heart rate was independently associated with cardiac death, however there was little evidence suggesting this association was explained by the presence of myocardial perfusion defects.
