resting heart rate is an important determinant of mortality in patients with pulmonary arterial...

E1271 JACC March 12, 2013 Volume 61, Issue 10 Pericardial/Myocardial Disease/Pulmonary Hypertension RESTING HEART RATE IS AN IMPORTANT DETERMINANT OF MORTALITY IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION DUE TO CONGENITAL HEART DISEASE Poster Contributions Poster Sessions, Expo North Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m. Session Title: Pulmonary Hypertension: Right Ventricle / Congenital Heart Disease Abstract Category: 27. Pulmonary Hypertension Presentation Number: 1208-156 Authors: Mark J. Schuuring, Annelieke van Riel, Jeroen Vis, Marielle Duffels, Rolf Berger, Elke Hoendermis, Arie Van Dijk, Hubert Vliegen, Barbara Mulder, Berto Bouma, Academic Medical Center, Amsterdam, The Netherlands Background: Pulmonary arterial hypertension due to congenital heart disease (CHD-PAH) remains a devastating disease. We aimed to determine early electrocardiographic (ECG) markers of mortality in this subset of patients. Methods: In this multicenter study we prospectively evaluated 75 consecutive adults (age 46 ± 13 years, 43% male) with CHD-PAH referred for advanced medical therapy. Heart rate (HR), PR interval, QRS duration and QT dispersion were derived from ECGs, which were performed routinely. Results: During a median follow up of 5.6 (range 0.2 to 7.5) years 19 patients died. Before treatment initiation (HR per 10-beats/min increase 1.58, 95% CI 1.15 to 2.17) a higher HR at rest was a determinant of mortality (p <0.01), see Table. Patients with a HR above 85 beats/min had a three times higher risk of mortality as compared to patients with a HR below 85 beats/min at rest (p = 0.03) Conclusion: ECG-derived heart rate at rest is an important marker of prognosis and could be involved in clinical decision making. Table Determinants of mortality in 75 consecutive patients with CHD-PAH Hazard ratio 95% CI p ECG at baseline Heart rate (per 10-beats / min increase) 1.58 1.15 - 2.17 < 0.01 PR interval (per 10 ms) 1.00 0.99 - 1.01 0.92 QRS duration (per 10 ms) 0.91 0.76 - 1.09 0.29 QT dispersion (per 10-ms increase) 1.07 0.91 - 1.25 0.43

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Page 1: RESTING HEART RATE IS AN IMPORTANT DETERMINANT OF MORTALITY IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION DUE TO CONGENITAL HEART DISEASE

E1271JACC March 12, 2013Volume 61, Issue 10

Pericardial/Myocardial Disease/Pulmonary Hypertension

resTing hearT raTe is an imporTanT deTerminanT of morTaliTy in paTienTs wiTh pulmonary arTerial hyperTension due To congeniTal hearT disease

Poster ContributionsPoster Sessions, Expo NorthSunday, March 10, 2013, 9:45 a.m.-10:30 a.m.

Session Title: Pulmonary Hypertension: Right Ventricle / Congenital Heart DiseaseAbstract Category: 27. Pulmonary HypertensionPresentation Number: 1208-156

Authors: Mark J. Schuuring, Annelieke van Riel, Jeroen Vis, Marielle Duffels, Rolf Berger, Elke Hoendermis, Arie Van Dijk, Hubert Vliegen, Barbara Mulder, Berto Bouma, Academic Medical Center, Amsterdam, The Netherlands

Background: Pulmonary arterial hypertension due to congenital heart disease (CHD-PAH) remains a devastating disease. We aimed to determine early electrocardiographic (ECG) markers of mortality in this subset of patients.

methods: In this multicenter study we prospectively evaluated 75 consecutive adults (age 46 ± 13 years, 43% male) with CHD-PAH referred for advanced medical therapy. Heart rate (HR), PR interval, QRS duration and QT dispersion were derived from ECGs, which were performed routinely.

results: During a median follow up of 5.6 (range 0.2 to 7.5) years 19 patients died. Before treatment initiation (HR per 10-beats/min increase 1.58, 95% CI 1.15 to 2.17) a higher HR at rest was a determinant of mortality (p <0.01), see Table. Patients with a HR above 85 beats/min had a three times higher risk of mortality as compared to patients with a HR below 85 beats/min at rest (p = 0.03)

conclusion: ECG-derived heart rate at rest is an important marker of prognosis and could be involved in clinical decision making.

Table Determinants of mortality in 75 consecutive patients with CHD-PAH

Hazard ratio 95% CI p

ECG at baseline

Heart rate (per 10-beats / min increase) 1.58 1.15 - 2.17 < 0.01

PR interval (per 10 ms) 1.00 0.99 - 1.01 0.92

QRS duration (per 10 ms) 0.91 0.76 - 1.09 0.29

QT dispersion (per 10-ms increase) 1.07 0.91 - 1.25 0.43

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