Heart Rate, Electrocardiographic Subclinical Myocardial Injury, and Long-Term Mortality
Patrick Cheon1, Mohamed A Mostafa2, Mai Z Soliman2
1Winston-Salem Campus, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA.
Journal of Clinical Medicine
|June 26, 2026
Summary
Elevated resting heart rate, or tachycardia, is linked to higher mortality. Subclinical myocardial injury (SCMI) may be an intermediary pathway, as it partially explains the association between tachycardia and mortality.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Elevated resting heart rate is associated with increased mortality.
- The underlying mechanisms linking heart rate to mortality are not fully understood.
- Subclinical myocardial injury (SCMI) is an asymptomatic indicator of cardiac damage with prognostic value.
Purpose of the Study:
- To investigate the association between resting heart rate categories and SCMI.
- To examine the relationship between resting heart rate and all-cause and cardiovascular mortality.
- To determine if SCMI mediates the association between heart rate and mortality.
Main Methods:
- Analysis of 7152 participants from NHANES III with electrocardiogram (ECG) data.
- Heart rate categorized as bradycardia (≤50 bpm), normal (>50-<100 bpm), or tachycardia (≥100 bpm).
- Mortality assessed via National Death Index linkage; logistic and Cox regression models used.
Main Results:
- SCMI was present in 24.3% of participants.
- Tachycardia was associated with increased odds of SCMI (adjusted OR 2.34).
- Tachycardia linked to higher all-cause (HR 3.58) and cardiovascular mortality (HR 2.05). SCMI attenuated these associations by 5% and 8.6%, respectively.
Conclusions:
- SCMI may be a potential intermediary pathway linking tachycardia to mortality.
- The association between tachycardia and mortality is partially explained by subclinical myocardial damage.
- Bradycardia was not associated with SCMI or mortality in this cohort.
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