Impact of Resting Heart Rate at 30 Days Following Transcatheter or Surgical Aortic Valve Replacement and Cardiovascular Outcomes: Insights from The PARTNER 2 Trial

ABSTRACT

Background: Elevated resting heart rate (RHR) is associated with adverse cardiovascular outcomes in patients with untreated aortic valve stenosis (AS). However, the impact of RHR following transcatheter (TAVR) or surgical aortic valve replacement (SAVR) on cardiovascular outcomes is unknown. We therefore sought to determine the effect of RHR at 30 days after aortic valve replacement (AVR) on 2-year outcomes in patients with severe symptomatic AS.

Methods: The study population consists of 3170 patients from the PARTNER 2 Trial and its embedded registries who underwent TAVR or SAVR for severe AS, and had available 12-lead electrocardiograms demonstrating sinus rhythm at 30 days post-procedure. Outcomes at 2 years were analyzed according to 30-day RHR modeled as a continuous variable and in groups (RHR ≥75 bpm and RHR <75 bpm).

Results: By multivariable analysis, RHR ≥75 bpm at 30 days after AVR was an independent predictor of the composite endpoint of all-cause death, rehospitalization or stroke (hazard ratio [HR] 1.26, 95% confidence interval [CI], 1.05–1.52, p = 0.015) and rehospitalization (HR 1.42, 95% CI, 1.12–1.79, p = 0.004). Similarly, RHR modeled as a continuous variable (per 5 bpm) remained an independent predictor of all-cause death, rehospitalization or stroke (adjusted HR 1.07, 95% CI, 1.03–1.11, p = 0.0007), and rehospitalization (adjusted HR 1.09, 95% CI, 1.04–1.14, p = 0.0003) at 2 years.

Conclusions: In patients with severe AS treated with TAVR or SAVR, resting heart rate at 30 days post-procedure was an independent predictor of the composite endpoint of all-cause death, rehospitalization or any stroke, and of rehospitalization at 2 years.

KEYWORDS:

• Aortic valve stenosis
• outcomes
• resting heart rate
• SAVR
• TAVR

Disclosure statements

Ms. Alu has received consulting fees from Claret Medical. Dr. Nazif has received consulting fees from Edwards Lifesciences. Dr. Babaliaros has received consulting fees from Edwards Lifesciences. Dr. Herrmann has received grants from Edwards Lifesciences, St. Jude Medical, Medtronic, Boston Scientific, Abbott Vascular, Gore, Siemens, Cardiokinetix, and Mitraspan, consulting fees from Edwards Lifesciences and Siemens, and holds equity in Microinterventional Devices. Dr. Makkar has received grants from Edwards Lifesciences and St. Jude Medical, consulting fees from Abbott Vascular, Cordis, and Medtronic, and holds equity in Entourage Medical. Dr. Webb has received consulting fees from Edwards Lifesciences and is a member of the PARTNER Trial Executive Committee (no direct compensation). Dr. Thourani serves on advisory boards for Edwards Lifesciences, Abbott Vascular, Gore Vascular, Bard Medical, Jenavalve, and Boston Scientific. Dr. Leon is a member of the PARTNER Trial Executive Committee (no direct compensation). Dr. Kodali has received consulting fees from Edwards Lifesciences, Medtronic, Claret Medical, Merrill Lifesciences, BioTrace Medical, and Microinterventional Devices, and has served on advisory boards for Thubrikar Aortic Valve, Dura Biotech, Abbott Vascular, Paieon Medical, and St. Jude Medical, and owns equity in Thubrikar Aortic Valve, Dura Biotech, BioTrace Medical, and Microinterventional Devices. The rest of the authors have nothing to disclose.

Supplemental data

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Additional information

Funding

The PARTNER 2 Trial was funded by Edwards Lifesciences.