Key result
Rising heart rate after HF therapy withdrawal links to ~70% higher DCM relapse risk per 10 bpm.
Why the study?
Understanding markers and mechanisms of relapse among patients with recovered dilated cardiomyopathy may enable personalized management.
Does the change in heart rate predict relapse during withdrawal of heart failure therapy in patients with recovered dilated cardiomyopathy?
Cohort (n=51)
Open-label
1:1
Yes
Does the change in heart rate predict relapse during withdrawal of heart failure therapy in patients with recovered dilated cardiomyopathy?
Effect estimate: HR 1.70 (95% CI 1.12-2.57)
p-value: p=0.01
In patients with recovered dilated cardiomyopathy, a rise in heart rate following the withdrawal of heart failure therapy is a significant marker identifying those more likely to experience relapse.
May flag higher relapse risk after withdrawal; extends predictor data in recovered dilated cardiomyopathy.
OBJECTIVES: The objective of this study was to determine the relationship between heart rate and relapse among patients in the TRED-HF (Therapy withdrawal in REcovered Dilated cardiomyopathy trial). BACKGROUND: Understanding markers and mechanisms of relapse among patients with recovered dilated cardiomyopathy (DCM) may enable personalized management. METHODS: The relationship between serial heart rate measurements and relapse was examined among patients in the TRED-HF trial, a randomized trial which examined the safety and feasibility of withdrawing heart failure therapy from 51 patients with recovered DCM over 6 months. In total, 25 patients were randomized to therapy withdrawal and 26 to continue therapy, of whom 25 subsequently began therapy withdrawal in a single arm crossover phase. RESULTS: The mean ± SD heart rate for those who had therapy withdrawn and did not relapse was 64.6 ± 10.7 beats/min at baseline and 74.7 ± 10.4 beats/min at follow-up, compared to 68.3 ± 11.3 beats/min at baseline and 86.1 ± 11.8 beats/min at follow-up for those who relapsed. After adjusting for differences in heart rate at baseline, patients who had therapy withdrawn and relapsed had a 10.4 beats/min (95% CI: 4.0-16.8) greater rise in heart rate than patients who had therapy withdrawn and did not relapse (P = 0.002). After data were adjusted for age, log N-terminal pro-B-type natriuretic peptide, and left ventricular ejection fraction (LVEF), heart rate (per 10 beats/min; hazard ratio [HR]: 1.65; 95% CI: 1.10-2.57; P = 0.01) and change in heart rate from baseline (per 10 beats/min; HR: 1.70; 95% CI: 1.12-2.57; p = 0.01) were associated with relapse. The results remained qualitatively the same after adjusting for beta-blocker dose. CONCLUSIONS: For patients with DCM and improved LVEF, the rise in heart rate after treatment is withdrawn treatment identifies patients who are more likely to relapse. Whether the increase in heart rate is a marker or a mediator of relapse requires investigation. (Therapy withdrawal in REcovered Dilated cardiomyopathy trial [TRED]; NCT02859311).
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Halliday et al. (2021) conducted a cohort in Recovered Dilated Cardiomyopathy (n=51). Withdrawal of heart failure therapy vs. Continuation of therapy was evaluated on Relapse of DCM (per 10 beats/min change in heart rate from baseline) (HR 1.70, 95% CI 1.12-2.57, p=0.01). In patients with recovered dilated cardiomyopathy, an increase in heart rate after withdrawal of heart failure therapy was associated with a higher risk of relapse (HR 1.70 per 10 beats/min increase).
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