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The impact of mean first-year heart rate on outcomes after heart transplantation: does it make a difference?

Ankit B Shah1, Jignesh K Patel, Matthew Rafiei

  • 1Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Clinical Transplantation
|August 9, 2013
PubMed

Insights

First-year heart rate (HR) after heart transplant does not predict long-term survival or rejection. However, high HRs may increase the risk of developing congestive heart failure (CHF).

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Immunology

Background:

  • Cardiac denervation after heart transplantation leads to variable heart rate (HR) changes.
  • The long-term implications of post-transplant HR on patient outcomes remain unclear.

Purpose of the Study:

  • To investigate the impact of the first-year heart rate on five-year outcomes in heart transplant recipients.
  • To determine if early post-transplant HR influences rejection, survival, cardiac allograft vasculopathy (CAV), or major adverse cardiac events (MACE).

Main Methods:

  • A cohort of 544 heart transplant recipients (1994-2008) was analyzed.
  • Patients were stratified into three groups based on mean first-year HR: <90 bpm, 90-110 bpm, and >110 bpm.
  • Outcomes assessed included one-year freedom from treated rejection, five-year survival, five-year freedom from CAV, and five-year freedom from non-fatal MACE (NF-MACE).

Main Results:

  • No significant differences were observed in one-year freedom from treated rejection, five-year survival, or five-year freedom from CAV across the HR groups.
  • Five-year freedom from NF-MACE was significantly lower in the highest HR group (≥110 bpm) compared to the intermediate group (90-110 bpm), primarily due to increased incidence of congestive heart failure (CHF).

Conclusions:

  • Mean first-year HR is not a significant prognostic indicator for one-year rejection, five-year survival, or CAV development post-heart transplant.
  • Elevated first-year HR may be associated with an increased risk of new-onset CHF in the long term.
  • Current findings suggest HR post-heart transplantation does not impact overall long-term outcomes but highlights a potential link to CHF development.
Abstract

Keywords:
cardiac allograft vasculopathyheart rateheart transplantationoutcomesrejection

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