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How to Estimate the Optimal Heart Rate in Patients with Heart Failure with Preserved Ejection Fraction
Toshihide Izumida1, Teruhiko Imamura1, Takuya Fukui1
1Second Department of Internal Medicine, University of Toyama.
Insights
Researchers identified an ideal heart rate (HR) for heart failure with preserved ejection fraction (HFpEF) patients. A new formula uses Doppler echocardiography measures to calculate this optimal HR, potentially improving cardiac output.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- The optimal heart rate (HR) for patients with heart failure with preserved ejection fraction (HFpEF) is not well-defined.
- Trans-mitral flow patterns, specifically the E-wave and A-wave overlap, are crucial indicators of cardiac function.
- Maximizing cardiac output is a key therapeutic goal in managing HFpEF.
Purpose of the Study:
- To hypothesize that maximum cardiac output occurs when E-wave and A-wave overlap is zero.
- To develop a formula for estimating the theoretically ideal HR in HFpEF patients.
- To investigate the association between E-wave and A-wave overlap, HR, and echocardiographic parameters.
Main Methods:
- Retrospective analysis of Doppler echocardiography data from 48 HFpEF patients.
- Multivariate linear regression to establish a formula for overlap length based on HR, deceleration time, and A-width.
- Validation of the derived formula in an independent cohort of 143 HFpEF patients.
Main Results:
- A formula was derived to estimate overlap length: -1,050 + 8.4 × (HR) + 0.6 × (deceleration time) + 1.7 × (A-width), showing strong agreement (r = 0.86).
- A novel formula for theoretically ideal HR was calculated: 125 - 0.07 × (deceleration time) - 0.20 × (A-width).
- The formula demonstrated strong agreement in estimating overlap in the validation cohort (r = 0.72).
Conclusions:
- A new formula can estimate theoretically ideal HR for HFpEF patients using deceleration time and A-width.
- This formula provides a novel approach to potentially optimize HR in HFpEF.
- Prospective studies are needed to confirm the clinical implications of targeting this ideal HR.
Abstract:
Ideal heart rate (HR), particularly for those with heart failure with preserved ejection fraction (HFpEF), remains unknown. We hypothesized that cardiac output would be maximum when the overlap between E-wave and A-wave at the trans-mitral flow is "zero" in the Doppler echocardiography. We retrospectively investigated the association among the overlap length between two waves, actual HR, and other echocardiographic parameters to construct a formula for estimating theoretically ideal HR among those with HFpEF. In total, 48 HFpEF patients were included (70-year-olds, 18 males). Given the results of multivariate linear regression analyses, the overlap length was estimated as follows: -1,050 + 8.4 × (HR [bpm]) + 0.6 × (deceleration time [millisecond]) + 1.7 × (A-width [millisecond]), which had a strong agreement with the actually measured overlap length (r = 0.86, P < 0.001). Theoretically ideal HR was calculated by substituting zero into the estimated overlap length as follows: 125 - 0.07 × (deceleration time [millisecond]) - 0.20 × (A-width [millisecond]). In the validation cohort including another 143 HFpEF patients, the estimated overlap using the formula again had a strong agreement with the actually measured overlap (r = 0.72, P < 0.001). In this study, we proposed a novel formula for calculating theoretically ideal HR, consisting of deceleration time and A-width, in the HFpEF cohort. Clinical implication to optimize the HR targeting the theoretically ideal HR should be investigated in prospective studies.
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