AIMS To investigate the relationship between heart rate and outcomes in heart failure and reduced ejection fraction (HFrEF) patients in sinus rhythm (SR) and atrial fibrillation (AF) adjusting for natriuretic peptide concentration, a powerful prognosticator. METHODS AND RESULTS Of 13 562 patients from two large HFrEF trials, 10 113 (74.6%) were in SR and 3449 (25.4%) in AF. The primary endpoint was the composite of cardiovascular death or heart failure hospitalization. Heart rate was analysed as a categorical (tertiles, T1-3) and continuous variable (per 10 bpm), separately in patients in SR and AF. Outcomes were adjusted for prognostic variables, including N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), and also examined using change from baseline heart rate to 1 year (≤ -10 bpm, ≥ +10 bpm, < ±10 bpm). SR patients with a higher heart rate had worse symptoms and quality of life, more often had diabetes and higher NT-proBNP concentrations. They had higher risk of the primary endpoint [T3 vs. T1 adjusted hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.35-1.66; P < 0.001; per 10 bpm: 1.12, 95% CI 1.09-1.16; P < 0.001]. In SR, heart rate was associated with a relatively higher risk of pump failure than sudden death (adjusted HR per 10 bpm 1.17, 95% CI 1.09-1.26; P < 0.001 vs. 1.07, 95% CI 1.02-1.13; P = 0.011). Heart rate was not predictive of any outcome in AF. CONCLUSIONS In HFrEF, an elevated heart rate was an independent predictor of adverse cardiovascular outcomes in patients in SR, even after adjustment for NT-proBNP. There was no relationship between heart rate and outcomes in AF. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers NCT01035255 and NCT00853658.

中文翻译：

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伴有心力衰竭和射血分数降低的窦性心律或房颤患者心率与预后之间的关系。

目的探讨心律和心力衰竭转归与窦性心律（SR）和心房颤动（AF）的射血分数降低（HFrEF）患者之间的关系，以调整利尿钠肽浓度（一种强有力的预后指标）。方法和结果两项大型HFrEF试验的13562例患者中，SR占10 113（74.6％），AF占3449（25.4％）。主要终点是心血管死亡或心力衰竭住院的综合因素。在SR和AF患者中，心率分别作为分类（三分位数，T1-3）和连续变量（每10 bpm）进行分析。调整预后变量的结果，包括B型利钠肽（NT-proBNP）的N端激素，并使用从基线心率到1年（≤-10 bpm，≥+10 bpm，<±10）的变化进行检查bpm）。具有较高心率的SR患者的症状和生活质量较差，患有糖尿病的患者和NT-proBNP浓度较高。他们的主要终点风险较高[T3与T1调整后的危险比（HR）为1.50，95％置信区间（CI）为1.35-1.66；P <0.001；每10 bpm：1.12，95％CI 1.09-1.16；P <0.001]。在SR中，与猝死相比，心率与相对较高的泵衰竭风险相关（每10 bpm调整后的HR 1.17,95％CI 1.09-1.26; P <0.001与1.07,95％CI 1.02-1.13; P = 0.011 ）。心率不能预测房颤的任何预后。结论在HFrEF中，即使调整了NT-proBNP，心律升高仍是SR患者不良心血管预后的独立预测指标。心律与心房颤动预后之间没有关系。临床试验注册临床试验。