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Prognostic Implications of Heart Rate Score and Its Temporal Change in Left Ventricular Systolic Dysfunction:
Masato Okada1, Koichi Inoue1,2, Nobuaki Tanaka1
1Cardiovascular Center Sakurabashi Watanabe Advanced Healthcare Hospital Osaka Japan.
Insights
Heart rate score (HrSc) of 70% or higher in Japanese patients with cardiac implantable electronic devices (CIEDs) did not predict outcomes. However, HrSc is a dynamic marker, with changes associated with clinical factors and heart failure events.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Heart rate score (HrSc) ≥70% indicates chronotropic incompetence and predicts prognosis in patients with cardiac implantable electronic devices (CIEDs) and left ventricular (LV) systolic dysfunction.
- The prognostic value of HrSc in Japanese patients and its longitudinal changes are not well understood.
Purpose of the Study:
- To evaluate the prognostic value of baseline HrSc ≥70% in Japanese patients with CIEDs.
- To characterize longitudinal changes in HrSc and identify associated factors in this population.
Main Methods:
- Post hoc analysis of the Heart Failure Indication and Sudden Cardiac Death Prevention Trial in Japan (HINODE).
- Included 172 patients with CIEDs and LV ejection fraction ≤50%.
- HrSc assessed via remote monitoring; longitudinal changes analyzed over 2 years.
Main Results:
- At baseline, 39.5% of patients had HrSc ≥70%.
- No significant difference in 2-year all-cause death or heart failure (HF) events between HrSc ≥70% and <70% groups (31.1% vs. 29.4%).
- Approximately one-quarter of patients experienced HrSc changes; increases were linked to lower LV ejection fraction, antiarrhythmic drug use, higher lower rate limit, and HF events.
Conclusions:
- Baseline HrSc ≥70% did not predict 2-year outcomes in the HINODE study cohort.
- HrSc is a dynamic marker, not static, reflecting evolving patient conditions and CIED programming.
- Changes in HrSc are associated with clinical and device-related factors, including HF events.
Background:
Heart rate score (HrSc) ≥ 70% reflects chronotropic incompetence and predicts prognosis in patients with cardiac implantable electronic devices (CIEDs) and left ventricular (LV) systolic dysfunction. However, its prognostic value in Japanese patients remains underexplored, and longitudinal changes in HrSc and their contributing factors are poorly characterized.
Methods:
This post hoc analysis of the Heart Failure Indication and Sudden Cardiac Death Prevention Trial in Japan (HINODE) included 172 patients with CIEDs and LV ejection fraction ≤ 50%. HrSc, defined as the percentage of all atrial-paced and sensed beats in a single tallest 10 beat/min device histogram bin, was assessed using remote monitoring.
Results:
At baseline, the median HrSc was 53% (interquartile range, 41%-83%), with 68 (39.5%) patients having HrSc ≥ 70%. During the 2-year follow-up, the incidence of all-cause death or heart failure (HF) events was similar between patients with HrSc ≥ 70% and < 70% (31.1% vs. 29.4%, log-rank p = 0.862). However, among 142 patients whose follow-up data were available, HrSc increased from < 70% to ≥ 70% in 13 patients (13%) and decreased from ≥ 70% to < 70% in 19 (9.1%). An increase in HrSc was associated with lower LV ejection fraction, antiarrhythmic drug initiation, increased lower rate limit, and HF events.
Conclusion:
In the HINODE study, baseline HrSc ≥ 70% was not predictive of 2-year cardiovascular outcomes. However, HrSc changed in approximately one-quarter of patients and was associated with clinical and device-related factors, as well as HF events. HrSc is not a static measure but a dynamic marker that reflects evolving patient conditions and CIED programming.
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