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Elevated preoperative heart rate is associated with cardiopulmonary and autonomic impairment in high-risk surgical patients

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posted on 20.08.2019, 14:42 by TEF Abbott, G Minto, AM Lee, RM Pearse, GL Ackland, A King, C Pollak, C Williams, A Patrick, C West, E Vickers, R Green, M Clark, J Whittle, LG Paredes, RCM Stephens, A Jones, J Otto, A Lach, AG Del Arroyo, A Toner, A Williams, T Owen, P Pradhu, D Hull, L Montague, S Iqbal, C Lyness, P Bodger, A Reyes, A Sciusco, S Cone, S Karmali, G Ackland, R Omar, M Singer, M Hamilton, S Mallett, M Malago, C Imber, A Windsor, R Hinchliffe, M Mughal, K Dawas, T Mould, M Cecconi, K Everingham, R Pearse, M Lees, R Shulman, N MacDonald, W Parnell, E Niebrzegowska, L Gallego, E McAlees, M Januszewska, A Smith, M Gillies, J Antonelli, C Beattie, C McCulloch, N Young, D Cameron, D McKeown, T Walsh, E Wilson, D Hope, A Hay, M Beatty, R Parks, K Lynn, M Blunt, P Young, P Moondi, J Gibson, J Carter, B Watson, H Hobbinger, S Abdy, R Pretorius, S Shafeek, K Wong, E Gent, R Wolf, G Wijewardena, B Young, M Irvine, S Elliot, K Griffiths, Z Beardow, A Breen, S Howell, S Birch, J Berridge, O Mohr, T Reynolds, E Fawcett, B Baytug, N Hester
Background: Elevated preoperative heart rate (HR) is associated with perioperative myocardial injury and death. In apparently healthy individuals, high resting HR is associated with development of cardiac failure. Given that patients with overt cardiac failure have poor perioperative outcomes, we hypothesized that subclinical cardiac failure, identified by cardiopulmonary exercise testing, was associated with elevated preoperative HR > 87 beats min-1(HR > 87). Methods: This was a secondary analysis of an observational cohort study of surgical patients aged ≥45 yr. The exposure of interest was HR > 87, recorded at rest before preoperative cardiopulmonary exercise testing. The predefined outcome measures were the following established predictors of mortality in patients with overt cardiac failure in the general population: ventilatory equivalent for carbon dioxide (V E/V co2) ratio ≥34, heart rate recovery ≤6 and peak oxygen uptake (V o2) ≤14 ml kg-1min-1. We used logistic regression analysis to test for association between HR > 87 and markers of cardiac failure. We also examined the relationship between HR > 87 and preoperative left ventricular stroke volume in a separate cohort of patients. Results: HR > 87 was present in 399/1250 (32%) patients, of whom 438/1250 (35%) had V E/V co2ratio ≥34, 200/1250 (16%) had heart rate recovery ≤6, and 396/1250 (32%) had peak V o2≤14 ml kg-1min-1. HR > 87 was independently associated with peak V o2≤14 ml kg-1min-1{odds ratio (OR) 1.69 [1.12-3.55]; P=0.01} and heart rate recovery ≤6 (OR 2.02 [1.30-3.14]; P<0.01). However, HR > 87 was not associated with V E/V co2ratio ≥34 (OR 1.31 [0.92-1.87]; P=0.14). In a separate cohort, HR > 87 (33/181; 18.5%) was associated with impaired preoperative stroke volume (OR 3.21 [1.26-8.20]; P=0.01). Conclusions: Elevated preoperative heart rate is associated with impaired cardiopulmonary performance consistent with clinically unsuspected, subclinical cardiac failure. Clinical trial registration. ISRCTN88456378.

Funding

Medical Research Council/British Journal of Anaesthesia clinical research training fellowship (grant reference MR/M017974/1 to T.E.F.A.); NIHR research professorship (R.M.P.); NIHR Cardiovascular Biomedical Research Unit at Barts Health NHS Trust and from the ‘SmartHeart’ EPSRC programme grant (EP/P001009/1 to A.M.L.); British Journal of Anaesthesia and Royal College of Anaesthetists (basic science career development award to G.L.A.); Royal College of Anaesthetists (British Oxygen Company research chair grant in anaesthesia to G.L.A.); British Heart Foundation Programme Grant (RG/14/4/30736 to G.L.A.).

History

Citation

British Journal of Anaesthesia, 2017, 119 (1), pp. 87-94

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

British Journal of Anaesthesia

Publisher

Elsevier

issn

0007-0912

eissn

1471-6771

Acceptance date

02/05/2017

Copyright date

2017

Available date

20/08/2019

Notes

Supplementary data is available from the publisher website at https://doi.org/10.1093/bja/aex164

Language

en

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