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Comparative Study
. 2018 Jan 31;18(1):17.
doi: 10.1186/s12872-018-0751-2.

Heart rate in patients with reduced ejection fraction: relationship between single time point measurement and mean heart rate on prolonged implantable cardioverter defibrillator monitoring

Marlena V Habal  1 , Kumaraswamy Nanthakumar  1   2 , Peter C Austin  1   3 , Cassandra Freitas  2   4 , Christopher Labos  3 , Douglas S Lee  5   6   7   8   9
Affiliations
Comparative Study

Heart rate in patients with reduced ejection fraction: relationship between single time point measurement and mean heart rate on prolonged implantable cardioverter defibrillator monitoring

Marlena V Habal et al. BMC Cardiovasc Disord. .

Abstract

Background: Heart rate (HR) is a prognostic marker that is increasingly used as a therapeutic target in patients with cardiovascular disease. The association between resting and mean HR remains unclear. We therefore set out to determine the relationship between resting HR on the electrocardiogram (ECG) obtained at a single time point, and mean HR on implantable cardioverter defibrillator (ICD) interrogation amongst patients with a reduced left ventricular ejection fraction (LVEF).

Methods: Prospective ICD data were obtained from 54 patients with LVEF < 40%. Mean HR determined using the ICD HR histograms was compared with resting HR measured on the ECG performed in the clinic.

Results: Average resting and ICD mean HRs were 67.9 ± 10.1 and 67.8 ± 9.6 bpm respectively. There was good correlation in the overall cohort (r = 0.79), in those with resting ECG HRs ≤ 70 bpm (r = 0.62), and amongst the 27 patients on intermediate-to-high dose beta-blockers (r = 0.91). However, Bland-Altman analysis demonstrated wide limits of agreement in the overall cohort (- 12.5, 12.7 bpm), at resting HRs ≤ 70 bpm (- 12.7, 9.8 bpm), and on intermediate-to-high dose beta-blockers (- 8.9, 7.4 bpm). Moreover, resting HR did not predict the 10-bpm interval where the most time was spent.

Conclusions: While resting HR correlated with mean HR in patients with reduced LVEF, and in important subgroups, the limits of agreement were unacceptably wide raising concern over the use of single time point resting HR as a therapeutic target.

Keywords: Beta-blockers; Mean heart rate; Resting heart rate.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the University Health Network Research Ethics Board and is in accordance with the guidelines outlined in the 1975 Declaration of Helsinki. After obtaining written informed consent from each patient, a rhythm strip and the HR histogram were printed following the patient’s regularly scheduled device interrogation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Resting HR/mean HR. b Bland-Altman Plot of resting HR/mean HR. HR, heart rate
Fig. 2
Fig. 2
a Resting HR/mean HR amongst the subgroup with resting HR ≤ 70 bpm. b Bland-Altman Plot of resting HR/mean HR amongst the subgroup with resting HR ≤ 70 bpm
Fig. 3
Fig. 3
a Resting HR/mean HR in the subgroup on an intermediate-to-high dose beta-blocker. b Bland-Altman Plot of resting HR/mean HR in the subgroup on an intermediate-to-high dose beta-blocker
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