Abbott, TEF;
Minto, G;
Lee, AM;
Pearse, RM;
Ackland, GL;
(2017)
Elevated preoperative heart rate is associated with cardiopulmonary and autonomic impairment in high-risk surgical patients.
British Journal of Anaesthesia
, 119
(1)
pp. 87-94.
10.1093/bja/aex164.
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Abstract
Background. Elevated preoperative heart rate (HR) is associated with perioperative myocardial injury and death. In apparently healthy individuals, high resting HR is associated with development of cardiac failure. Given that patients with overt cardiac failure have poor perioperative outcomes, we hypothesized that subclinical cardiac failure, identified by cardiopulmonary exercise testing, was associated with elevated preoperative HR > 87 beats min1 (HR > 87). / Methods. This was a secondary analysis of an observational cohort study of surgical patients aged 45 yr. The exposure of interest was HR > 87, recorded at rest before preoperative cardiopulmonary exercise testing. The predefined outcome measures were the following established predictors of mortality in patients with overt cardiac failure in the general population: ventilatory equivalent for carbon dioxide (V_ E=V_ co2) ratio 34, heart rate recovery �6 and peak oxygen uptake (V_ o2) �14 ml kg1 min1 . We used logistic regression analysis to test for association between HR > 87 and markers of cardiac failure. We also examined the relationship between HR > 87 and preoperative left ventricular stroke volume in a separate cohort of patients. / Results. HR > 87 was present in 399/1250 (32%) patients, of whom 438/1250 (35%) had V_ E=V_ co2 ratio 34, 200/1250 (16%) had heart rate recovery �6, and 396/1250 (32%) had peak V_ o2 �14 ml kg1 min1 . HR > 87 was independently associated with peak V_ o2 �14 ml kg1 min1 {odds ratio (OR) 1.69 [1.12–3.55]; P¼0.01} and heart rate recovery �6 (OR 2.02 [1.30–3.14]; P<0.01). However, HR > 87 was not associated with V_ E=V_ co2 ratio 34 (OR 1.31 [0.92–1.87]; P¼0.14). In a separate cohort, HR > 87 (33/ 181; 18.5%) was associated with impaired preoperative stroke volume (OR 3.21 [1.26–8.20]; P¼0.01). / Conclusions. Elevated preoperative heart rate is associated with impaired cardiopulmonary performance consistent with clinically unsuspected, subclinical cardiac failure. / Clinical trial registration. ISRCTN88456378.
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