Effect of Heart Rate on Early Progression of Cardiac Allograft Vasculopathy: A Prospective Study Using Highly Automated 3-D Optical Coherence Tomography Analysis

Abstract

Purpose Despite the controversial effect of elevated heart rate on progression of cardiac allograft vasculopathy (CAV), heart-rate-slowing agents are frequently prescribed with the assumption that higher heart rate predicts worse outcomes in cardiovascular disease. Methods This prospective 2-center trial investigated progression of CAV in 116 heart transplant (HTx) patients. Both baseline (1 month after HTx) and follow-up (12 months after HTx) examinations by coronary optical coherence tomography (OCT) were analyzed using highly automated 3D graph-based segmentation software. Mean heart rate was assessed by 24-hour ambulatory ECG monitoring at baseline and at 12-month follow-ups after HTx. Results During the first post-transplant year, significant reduction in the mean coronary luminal area from 8.9±2.4 to 7.8±2.3 mm2 (p Conclusion Heart-rate-slowing treatment in HTx patients may not be essential because our study did not confirm significant relationships between the mean heart rate and 12-month progression of CAV. As this was investigated in HTx patients who were treated by beta-blockers at the discretion of attending physicians, a randomized study is warranted to assess the heart rate effect on CAV progression. This work was supported in part by the grants from the National Institutes of Health (R01-EB004640), Ministry of Health of the Czech Republic (16-27465A, 16-28525A, 17-28784A - all rights reserved), and IKEM (MH-CZ-DRO-IKEM-IN 00023001).