Heart Rate As a Biomarker in Heart Failure: Role of Heart Rate Lowering Agents

Abstract

Heart failure (HF) is a common clinical condition affecting more than 5.8 million people in the United States, it remains the leading cause of death in the United States and worldwide. Ongoing challenges for biomarker identification include the need for objective assessment, measurement precision, and meaningful replication. Biomarkers not only serve as traditional predictors of prognosis, they can also help to identify high-risk patients who need closer monitoring and more aggressive therapy; therefore, we reviewed the use of heart rate (HR) as a biomarker in HF both of diagnostic and prognostic values, in addition, to being easily detected. HR is a determinant of myocardial oxygen demand, coronary blood flow, and myocardial performance and is central to the adaptation of cardiac output to metabolic needs. Increased HR is known to predict adverse outcome in the general population and in patients with chronic HF. Part of the ability of HR to predict risk is related to the forces driving it, namely, neurohormonal activation. We reviewed therapies, which slow the HR like β-blockers and ivabradine (a drug that is a pure HR-reducing agent), and all the clinical studies suggest the benefit of these drugs in the management of HF, and increasing evidence suggests HR as a biomarker of both diagnostic and prognostic values in HF.

Going beyond the mean in examining relationships of adolescent non-cognitive skills with health-related quality of life and biomarkers in later-life

“… Heart rate Heart rate is a determinant of myocardial oxygen demand, coronary blood flow, and myocardial performance and is central to the adaptation of cardiac output to metabolic needs. Increased heart rate is known to predict adverse outcome in the general population and in patients with chronic heart failure ( Shaaya et al, 2017 ). Expiratory flow The peak expiratory flow test is a common test that helps to diagnose and check lung problems, such as asthma and chronic obstructive pulmonary disease ( So et al, 2016 ).…”

PK/PD Modeling of β-Blockers in Cardiovascular Disease: An Update

“…In this context, after adjusting for the blood pressure reduction, only small differences were found in the incidence of cardiovascular m orbidity and mortality comparative clinical trials of antihypertensive drug classes [2]. On the other hand, heart rate determines myocardial oxygen demand, coronary blood flow and myocardial performance and plays a central role in the adaptation of cardiac output (CO) to metabolic needs [22]. Increase in heart rate contributes to adverse outcome in the general and in patients with chronic heart failure [22].…”

“…The main cardiovascular parameters influenced by β-blockers, especially blood pressure and heart rate, meet the validation requirements of measured effects, including continuity, sensitivity, objectivity and repeatability [20]. In addition, blood pressure and heart rate seem to be excellent biomarker of the long-term benefits of β-blockers in hypertension and cardiac failure, respectively [20][21][22]. Blood pressure has been established as a surrogate end point of the degree of reduction of major cardiovascular events in hypertensive patients, based on the basis of epidemiologic data and numerous clinical trials [20].…”

“…Increase in heart rate contributes to adverse outcome in the general and in patients with chronic heart failure [22]. Taking into account that heart rate increases to compensate for the deficit of the heart pumping action, it can be considered a good biomarker both in the diagnosis and prognosis of patients with heart insufficiency [22]. Meta-analysis of clinical trials, including almost 20,000 patients, has found that the degree of heart reduction induced by β-blockers is associated with a reduction of cardiovascular outcomes and death [22].…”

“…On the other hand, heart rate determines myocardial oxygen demand, coronary blood flow and myocardial performance and plays a central role in the adaptation of cardiac output (CO) to metabolic needs [22]. Increase in heart rate contributes to adverse outcome in the general and in patients with chronic heart failure [22]. Taking into account that heart rate increases to compensate for the deficit of the heart pumping action, it can be considered a good biomarker both in the diagnosis and prognosis of patients with heart insufficiency [22].…”