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Elevated preoperative heart rate is associated with cardiopulmonary and autonomic impairment in high-risk surgical patients

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. Green open access

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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.

Type: Article
Title: Elevated preoperative heart rate is associated with cardiopulmonary and autonomic impairment in high-risk surgical patients
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/bja/aex164
Publisher version: https://doi.org/10.1093/bja/aex164
Language: English
Additional information: Copyright © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: cardiac failure; heart rate; surgery
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10119805
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