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Titolo	Heart rate as independent prognostic factor for mortality in normotensive hemodialysed patients
Autore	Gennaro Cice1, Attilio Di Benedetto2, Antonello D?Andrea1, Salvatore D?Isa1, Paola De Gregorio1, Daniele Marcelli3, Emanuele Gatti3, Raffaele Calabrò1 - 1 Department of Cardiology, Second University of Naples, Naples - Italy; 2 NephroCare Italy, Naples - Italy; 3 Fresenius Medical Care, Bad Homburg - Germany
Referenza	J Nephrol 2008; 21: 704-712
Contenuto	Background: Several epidemiological studies have reported heart rate (HR) as a predictor of cardiovascular and noncardiovascular mortality in the general population. Aim of the present study was to investigate a possible relation between increased HR and mortality in normotensive end-stage renal disease (ERSD) patients. Methods: Between 1997 and 2001 we recruited 407 normotensive ESRD patients (mean age 56.6 ± 3.3 years) without coronary artery disease, left ventricular systolic dysfunction or on antiarrhythmic therapy. Baseline electrocardiography (ECG) at rest, 48-hour ambulatory Holter ECG monitoring and standard echocardiography were performed. After a mean follow-up of 46 months (range 12-60 months), cardiovascular and sudden death were considered as end points. Results: Echocardiogram showed a normal left ventricular ejection fraction (>55%) in 370 patients (91%) and left ventricular hypertrophy (LVH) in 290 patients (71.2%). Mean HR by 48-hour Holter ECG was 81 ± 10.6 bpm. During the follow-up, all-cause mortality rate was 12% (49 patients); 40 patients died from cardiac cause (9.8%) of which 20 patients (4.9%) by sudden death. By univariate analysis, age, diabetes, ECG-LVH with signs of left ventricular strain, and increased mean HR by 48-hour Holter ECG were all significantly related to global, cardiovascular and sudden death. ROC curve analysis identified optimal cutoff points for HR >85 bpm and age >65 years associated with increased cardiovascular risk (p<0.001). By Cox regression analysis, only age >65 years (p<0.0001) and mean HR >85 bpm (p<0.0001) were independent predictors of cardiovascular events. Conclusions: In normotensive ERSD patients, increased mean HR detected by 48-hour Holter ECG is an independent determinant of global and cardiovascular mortality.
Data	22.10.2008

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