Effect of resting heart rate on two-year clinical outcomes of high-risk patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve implantation.

Abstract

Resting heart rate (HRate) is a modifiable risk factor among patients with cardiovascular disease, including aortic stenosis (AS). However, the effect of resting HRate on clinical outcomes of patients with severe symptomatic AS undergoing transcatheter aortic valve implantation (TAVI) is unknown. Our aim was therefore to assess the effect of resting HRate on clinical outcomes among high-risk patients with symptomatic severe AS in normal sinus rhythm (NSR) undergoing TAVI. Of 606 consecutive patients undergoing TAVI, 349 (57.6%) with severe AS and a baseline 12-lead electrocardiogram (ECG) showing NSR undergoing TAVI were analysed. Patients were dichotomised into low HRate (LHR; <77 beats per minute [bpm]) and high HRate (HHR; ≥77 bpm) groups. The primary endpoint was all-cause mortality at two years. As compared with baseline LHR, no significant differences in all-cause mortality at two years (adjusted [adj] hazard ratio [HR] 1.23, p=0.40) were observed among patients with baseline HHR. Of 197 patients with available discharge ECGs remaining in NSR, mean HRate significantly increased among LHR patients (∆HRate 8.35, p<0.001) but decreased among HHR patients (∆HRate -4.88, p<0.001). On thirty-day landmark analysis, discharge HHR was significantly associated with two-year all-cause mortality (HR 2.30, 95% CI: 1.16-4.56, p=0.017), but not after extensive adjustment for comorbidities (adj HR 2.01, 95% CI: 0.98-4.09, p=0.056). A significant interaction for two-year mortality (p-interaction 0.021) was observed on landmark analysis for discharge, but not baseline, HHR. Baseline and discharge resting HRate were not associated with adverse outcomes after TAVI.