Key result
While resting heart rate correlated with mean heart rate on prolonged ICD monitoring (r = 0.79), the limits of agreement were unacceptably wide (-12.5 to 12.7 bpm), raising concern over its use as a therapeutic target.
Why the study?
Does single time point resting heart rate accurately reflect mean heart rate on prolonged ICD monitoring in patients with reduced ejection fraction?
Observational (n=54)
No
Does single time point resting heart rate accurately reflect mean heart rate on prolonged ICD monitoring in patients with reduced ejection fraction?
Single time point resting heart rate has unacceptably wide limits of agreement with mean heart rate from prolonged ICD monitoring, raising concerns about its use as a therapeutic target for titrating chronotropic medications.
Single resting heart rate should not yet guide chronotropic titration in HFrEF; leaves open whether prolonged ICD monitoring better informs targets.
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.
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Habal et al. (2018) conducted an observational in Reduced left ventricular ejection fraction (LVEF < 40%) with ICD (n=54). Resting heart rate on ECG at a single time point vs. Mean heart rate on prolonged ICD monitoring was evaluated on Agreement between resting HR on the ECG at a single time point and mean HR from the ICD interrogation (r = 0.79, 95% CI -12.5 to 12.7, p=<0.001). While resting heart rate correlated with mean heart rate on prolonged ICD monitoring (r = 0.79), the limits of agreement were unacceptably wide (-12.5 to 12.7 bpm), raising concern over its use as a therapeutic target.
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