Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: The SEAS study

Anders M Greve; Casper N Bang; Ronan M G Berg; Kenneth Egstrup; Anne B Rossebø; Kurt Boman; Christoph A Nienaber; Simon Ray; Christa Gohlke-Baerwolf; Olav W Nielsen; Peter M Okin; Richard B Devereux; Lars Køber; Kristian Wachtell

doi:10.1016/j.ijcard.2014.11.181

Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: The SEAS study

Anders M Greve, Casper N Bang, Ronan M G Berg, Kenneth Egstrup, Anne B Rossebø, Kurt Boman, Christoph A Nienaber, Simon Ray, Christa Gohlke-Baerwolf, Olav W Nielsen, Peter M Okin, Richard B Devereux, Lars Køber, Kristian Wachtell

8 Citations (Scopus)

Abstract

BACKGROUND: An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown.

METHODS: RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se.

RESULTS: 1563 patients were followed for a mean of 4.3years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n=151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10min(-1) faster, 95% CI: 1.0-1.7, both p≤0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-1) faster, 95% CI: 1.2-1.7, both p≤0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p≥0.06 for interaction).

CONCLUSIONS: RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677).

Original language	English
Journal	International Journal of Cardiology
Volume	180
Pages (from-to)	122-128
Number of pages	7
ISSN	0167-5273
DOIs	https://doi.org/10.1016/j.ijcard.2014.11.181
Publication status	Published - 1 Feb 2015

Keywords

Aged
Anticholesteremic Agents
Aortic Valve Stenosis
Atrial Fibrillation
Azetidines
Double-Blind Method
Drug Therapy, Combination
Ezetimibe
Female
Follow-Up Studies
Global Health
Heart Failure
Heart Rate
Humans
Male
Middle Aged
Prognosis
Proportional Hazards Models
Prospective Studies
Rest
Simvastatin
Survival Rate
Time Factors

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10.1016/j.ijcard.2014.11.181

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Greve, A. M., Bang, C. N., Berg, R. M. G., Egstrup, K., Rossebø, A. B., Boman, K., Nienaber, C. A., Ray, S., Gohlke-Baerwolf, C., Nielsen, O. W., Okin, P. M., Devereux, R. B., Køber, L., & Wachtell, K. (2015). Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: The SEAS study. International Journal of Cardiology, 180, 122-128. https://doi.org/10.1016/j.ijcard.2014.11.181

Greve, AM, Bang, CN, Berg, RMG, Egstrup, K, Rossebø, AB, Boman, K, Nienaber, CA, Ray, S, Gohlke-Baerwolf, C, Nielsen, OW, Okin, PM, Devereux, RB, Køber, L & Wachtell, K 2015, 'Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: The SEAS study', International Journal of Cardiology, vol. 180, pp. 122-128. https://doi.org/10.1016/j.ijcard.2014.11.181

@article{b6b0af302e08488aa686d16de65013cb,

title = "Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: The SEAS study",

abstract = "BACKGROUND: An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown.METHODS: RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se.RESULTS: 1563 patients were followed for a mean of 4.3years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n=151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10min(-1) faster, 95% CI: 1.0-1.7, both p≤0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-1) faster, 95% CI: 1.2-1.7, both p≤0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p≥0.06 for interaction).CONCLUSIONS: RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677).",

keywords = "Aged, Anticholesteremic Agents, Aortic Valve Stenosis, Atrial Fibrillation, Azetidines, Double-Blind Method, Drug Therapy, Combination, Ezetimibe, Female, Follow-Up Studies, Global Health, Heart Failure, Heart Rate, Humans, Male, Middle Aged, Prognosis, Proportional Hazards Models, Prospective Studies, Rest, Simvastatin, Survival Rate, Time Factors",

author = "Greve, {Anders M} and Bang, {Casper N} and Berg, {Ronan M G} and Kenneth Egstrup and Rosseb{\o}, {Anne B} and Kurt Boman and Nienaber, {Christoph A} and Simon Ray and Christa Gohlke-Baerwolf and Nielsen, {Olav W} and Okin, {Peter M} and Devereux, {Richard B} and Lars K{\o}ber and Kristian Wachtell",

year = "2015",

month = feb,

day = "1",

doi = "10.1016/j.ijcard.2014.11.181",

language = "English",

volume = "180",

pages = "122--128",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis

T2 - The SEAS study

AU - Greve, Anders M

AU - Bang, Casper N

AU - Berg, Ronan M G

AU - Egstrup, Kenneth

AU - Rossebø, Anne B

AU - Boman, Kurt

AU - Nienaber, Christoph A

AU - Ray, Simon

AU - Gohlke-Baerwolf, Christa

AU - Nielsen, Olav W

AU - Okin, Peter M

AU - Devereux, Richard B

AU - Køber, Lars

AU - Wachtell, Kristian

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BACKGROUND: An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown.METHODS: RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se.RESULTS: 1563 patients were followed for a mean of 4.3years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n=151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10min(-1) faster, 95% CI: 1.0-1.7, both p≤0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-1) faster, 95% CI: 1.2-1.7, both p≤0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p≥0.06 for interaction).CONCLUSIONS: RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677).

AB - BACKGROUND: An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown.METHODS: RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se.RESULTS: 1563 patients were followed for a mean of 4.3years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n=151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10min(-1) faster, 95% CI: 1.0-1.7, both p≤0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-1) faster, 95% CI: 1.2-1.7, both p≤0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p≥0.06 for interaction).CONCLUSIONS: RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677).

KW - Aged

KW - Anticholesteremic Agents

KW - Aortic Valve Stenosis

KW - Atrial Fibrillation

KW - Azetidines

KW - Double-Blind Method

KW - Drug Therapy, Combination

KW - Ezetimibe

KW - Female

KW - Follow-Up Studies

KW - Global Health

KW - Heart Failure

KW - Heart Rate

KW - Humans

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Rest

KW - Simvastatin

KW - Survival Rate

KW - Time Factors

U2 - 10.1016/j.ijcard.2014.11.181

DO - 10.1016/j.ijcard.2014.11.181

M3 - Journal article

C2 - 25438232

SN - 0167-5273

VL - 180

SP - 122

EP - 128

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: The SEAS study

Abstract

Keywords

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