Elevated Heart Rate Following Heart Transplantation Is Associated With Increased Graft Vasculopathy and Mortality

Heart rate and early progression of cardiac allograft vasculopathy: A prospective study using highly automated 3‐D optical coherence tomography analysis

“…Despite the significant early IT progression observed in our relatively large cohort of 116 patients, no significant risk factors of CAV development were identified in respect of selected donor‐related characteristics or non‐immunological risk factors. This confirms the indisputable role of immune mechanisms in CAV development, such as donor‐specific anti‐HLA antibodies, which are particularly prevalent in early stages of CAV disease and characterized by diffuse concentric fibrous intimal hyperplasia . Traditional cardiovascular risk factors contribute to the CAV progression rather in the later stages of CAV development (beyond 1 year after HTx), which are characterized by the diffuse incorporation of lipids into the vessel wall and resemble classical processes in ischemic heart disease …”

“…Such efforts are particularly hampered by the use of low‐resolution coronary angiography as an imaging modality for CAV assessment and a reliance on single ambulatory ECG recordings for HR analysis. In contradiction to previous studies on this topic, recent data published by Liebo et al reveal that a HR >95 beats/min 1 year after HTx is associated with increased incidence of CAV. In this context, the results of our prospective study—utilizing 24‐hour ECG Holter monitoring for HR assessment and OCT imaging for detailed and precise analysis of early ΔIT—are of major importance.…”

“…Current data on the effects of increased resting HR on all‐cause mortality in HTx patients and CAV development are contradictory. While there is relatively uniform evidence of tachycardia‐related effects on mortality, the impact on CAV development is less clear . Due to small sample sizes, retrospective and observational approaches, and overall design, previous studieshave failed to produce convincing data on the role of tachycardia in CAV development.…”

“…Faster HR results in decreased shear stress, leading to stimulation of mechanoreceptors located on the surface of the endothelium and upregulation of proatherogenic genes, effects that can lead to endothelial dysfunction and affect graft outcomes . However, reports on the relationship between elevated HR and cardiac allograft vasculopathy (CAV) development have reported contradictory and inconsistent results . All the studies published on the subject suffer from significant limitations, mainly due to retrospective analysis, the use of coronary angiography as a CAV imaging modality, and the use of single ECG recording as a HR rate analysis tool .…”

“…(CAV) development have reported contradictory and inconsistent results. [7][8][9][10] All the studies published on the subject suffer from significant limitations, mainly due to retrospective analysis, the use of coronary angiography as a CAV imaging modality, and the use of single ECG recording as a HR rate analysis tool. [7][8][9][10] Our aim was to perform a large prospective study using highly automated optical coherence tomography (OCT) image analysis and 24-hour ECG monitoring as a means of elucidating the relationship between HR and early progression of CAV.…”