Heart Rate in Coronary Syndromes and Heart Failure
Section snippets
Heart rate as cardiovascular and metabolic risk factor
The relationship between resting HR and cardiovascular risk and mortality has been clearly established in several large epidemiological studies for the last 30 years either in healthy subjects or in those affected by different cardiovascular diseases. In 1981, data derived from the Paris Prospective Study demonstrated that resting HR was able to predict total mortality in both men and women in 19,386 employees observed for more than 20 years. In men, the risk of cardiovascular mortality was
Heart rate and coronary artery disease
Coronary artery disease is common in the general population and represents an important public health problem; several epidemiological and clinical studies have identified well-known risk factors such as dyslipidemia, hypertension, diabetes mellitus, cigarette smoking, and obesity. All these factors may promote coronary atherosclerosis that is the pathophysiologic basis of the broad spectrum of clinical presentations of ischemic heart disease. Besides these classical risk factors, more
Heart rate and left ventricular dysfunction
The relation between resting HR and left ventricular dysfunction has been studied both in humans and animal models. In a recent study,33 the effect of different pacing rates (80 vs 60 bpm) on ventricular function of patients with heart failure and severe left ventricular systolic dysfunction (mean left ventricular ejection fraction, 26% ± 9%) treated with β-blockers was evaluated. Higher pacing rates (80 bpm) significantly increased mean left ventricular end-diastolic and systolic volumes and
Conclusion and future perspectives
According to the results presented in this review, we can conclude that there are consistent evidences that resting HR is able to predict life expectancy and, in healthy subjects, is an independent predictor of morbidity and mortality. Furthermore, resting HR is a predictor of death in both stable coronary artery disease and ACS, and these evidences are clearly supported by pathophysiologic background, clinical observations, and randomized clinical trials.
Elevated resting HR is also able to
Statement of Conflict of Interest
All authors declare that there are no conflicts of interest.
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Statement of Conflict of Interest: see page 44.