Heart rate as a marker of relapse during withdrawal of therapy in recovered dilated cardiomyopathy

Halliday, B. P. et al. (2021) Heart rate as a marker of relapse during withdrawal of therapy in recovered dilated cardiomyopathy. JACC: Heart Failure, 9(7), pp. 509-517. (doi: 10.1016/j.jchf.2021.03.010) (PMID:34119469) (PMCID:PMC8259664)

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Objectives: The objective of this study was to determine the relationship between heart rate and relapse among patients in the TRED-HF (Therapy withdrawal in REcovered Dilated cardiomyopathy trial). Background: Understanding markers and mechanisms of relapse among patients with recovered dilated cardiomyopathy (DCM) may enable personalized management. Methods: The relationship between serial heart rate measurements and relapse was examined among patients in the TRED-HF trial, a randomized trial which examined the safety and feasibility of withdrawing heart failure therapy from 51 patients with recovered DCM over 6 months. In total, 25 patients were randomized to therapy withdrawal and 26 to continue therapy, of whom 25 subsequently began therapy withdrawal in a single arm crossover phase. Results: The mean ± SD heart rate for those who had therapy withdrawn and did not relapse was 64.6 ± 10.7 beats/min at baseline and 74.7 ± 10.4 beats/min at follow-up, compared to 68.3 ± 11.3 beats/min at baseline and 86.1 ± 11.8 beats/min at follow-up for those who relapsed. After adjusting for differences in heart rate at baseline, patients who had therapy withdrawn and relapsed had a 10.4 beats/min (95% CI: 4.0–16.8) greater rise in heart rate than patients who had therapy withdrawn and did not relapse (P = 0.002). After data were adjusted for age, log N-terminal pro–B-type natriuretic peptide, and left ventricular ejection fraction (LVEF), heart rate (per 10 beats/min; hazard ratio [HR]: 1.65; 95% CI: 1.10-2.57; P = 0.01) and change in heart rate from baseline (per 10 beats/min; HR: 1.70; 95% CI: 1.12–2.57; p = 0.01) were associated with relapse. The results remained qualitatively the same after adjusting for beta-blocker dose. Conclusions: For patients with DCM and improved LVEF, the rise in heart rate after treatment is withdrawn treatment identifies patients who are more likely to relapse. Whether the increase in heart rate is a marker or a mediator of relapse requires investigation. (Therapy withdrawal in REcovered Dilated cardiomyopathy trial [TRED]; NCT02859311).

Item Type:Articles
Additional Information:TRED-HF was an investigator-led trial sponsored by Royal Brompton and Harefield NHS Trust. The study was funded by a Clinical Research Training Fellowship from the British Heart Foundation (FS/15/29/31492) awarded to BPH and SKP and received additional support from the Alexander Jansons Foundation, the Cardiovascular Research Centre and NIHR Biomedical Research Unit at Royal Brompton Hospital, the NIHR Imperial College Biomedical Research Centre and grants from Rosetrees Trust awarded to SKP. BPH is also supported by a Clinical Lecturer Starter Grant from the Academy of Medical Sciences (SGL021\1025). JGFC received support from a Centre of Research Excellence award from the British Heart Foundation (RE/18/6/34217).
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Halliday, B. P., Vazir, A., Owen, R., Gregson, J., Wassall, R., Lota, A. S., Khalique, Z., Tayal, U., Jones, R. E., Hammersley, D., Pantazis, A., Baksi, A. J., Rosen, S., Pennell, D. J., Cowie, M. R., Cleland, J. G.F., and Prasad, S. K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:JACC: Heart Failure
ISSN (Online):2213-1787
Published Online:09 June 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in JACC: Heart Failure 9(7): 509-517
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science