Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Diagnostic and Prognostic Impact of Increased Heart Rate on Admission in Patients with Cardiogenic Shock

J. Rusnak1, T. Schupp1, K. J. Weidner1, M. Ruka1, S. Egner-Walter1, J. Forner1, T. Bertsch2, M. Kittel3, K. A. Mashayekhi4, P. Tajti5, M. Ayoub6, M. Behnes1, I. Akin1

1I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; 2Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg Nord, Nürnberg; 3Institut für klinische Chemie, Universitätsmedizin Mannheim (UMM), Mannheim; 4Innere Medizin und Kardiologie, MediClin Herzzentrum Lahr/Baden, Lahr/Schwarzwald; 5Gottsegen György National Cardiovascular Center, Budapest, HU; 6Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Objective: The study investigates the diagnostic and prognostic role of heart rate (HR) in patients with cardiogenic shock (CS).             Background: In critically ill patients high HR is known to be a negative predictor. However, studies regarding the prognostic impact of HR in patients with CS is limited.   Methods: Consecutive patients with CS from June 2019 to Mai 2021 were included monocentrically. HR was documented on admission for each patient. Firstly, the diagnostic value of HR was tested in the entire cohort as well as in the subgroup of patients with and without acute myocardial infarction (AMI). Secondly, the prognostic value of a high HR was investigated regarding the impact on 30-day all-cause mortality. Statistical analyses included univariable t-test, Spearman´s correlation, C-statistics, Kaplan-Meier analyses, as well as Cox proportional regression analyses.   Results: 260 patients with CS were included. HR on admission was higher in patients that survived the follow-up time of 30 days (85 bpm vs. 94 bpm; p = 0.049). HR on admission showed a better discrimination in patients with AMI (AUC: 0.632) compared to non-AMI (AUC: 0.526). Furthermore, HR on admission was associated with higher all-cause mortality on day 30 in univariable (HR = 1.007; 95 % CI 1.001 – 1.013; p = 0.021) and multivariable COX regression model (HR = 1.007; 95 % CI 1.001 – 1.014; p = 0.033). However, this association was solely driven by patients with AMI (HR = 1.012; 95 % CI 1.001 – 1.023; p = 0.029), whereas HR was not associated with the primary endpoint of 30-day all-cause-mortality in non-AMI patients (HR = 1.003; 95 % CI 0.994 – 1.012; p = 0.512). The presence of HR > 110 bpm was associated with a significantly increased 30-day all-cause mortality in Kaplan Meier analysis in the entire cohort (51 % vs. 64 %; log-rank p = 0.022) and in patients with AMI (57 % vs. 80 %; log-rank p = 0.002), whereas no difference could be seen in patients without AMI (log-rank p = 0.525).   Conclusion: HR on admission was significantly associated with increased 30-day all-cause mortality in patients with CS as well as in the subgroup of CS-patients with AMI, whereas no significant association could be seen in CS-patients without AMI. HR > 110 bpm might be a good cut-off value for risk prediction.

https://dgk.org/kongress_programme/jt2023/aP2128.html