The Influence Of Elevated Resting Heart Rate And Strengthening Heart Rate Control On Patients’ Cardiac Function And Renal Function With Chronic Heart Failure

Objectives: This experiment illustrated the influence of elevated resting heart rate(RHR) on patients with chronic heart failure(CHF). And then compared with the influence of strengthening heart rate control on their cardiac structure and funtion,renal function and prognosis. The purpose of this experiment was to aroused the awareness of elevated RHR and provided clinical support for the heart rate control with chronic heart failure.Methods: The retrospective analysis was adopted in this experiment by selecting the patients in the cardiovascular medicine of Loudi affiliated hospital,University of South China from August 2013 to August 2014. Totally 270 patients were diagnosed with CHF and cardiac function classification of New York of level Ⅲ.Their diagnosis also conbined heart medical history which last more than 3 months,congested symptoms of systemic circulation and/or pulmonary circulation and auxiliary examinations such as N-terminal pro-B-type natriuretic peptide(NT- pro BNP),left ventricular ejection fraction(LVEF)and so on. Then we recorded these patients’ general information and biochemical criterions which contain NT-pro BNP, uric acid(UA),creatinine(Cre),cystatin C(Cys C),fasting plasma glucose(FPG),total cholesterol(TC), triglyceride(TG),cadiac troponin I(c Tn I), creatine kinase(CK),creatine kinase-MB isoenzyme(CK-MB)and so on. According to the standard of whether the RHR was above 80 times per minute, these patients were divided into two groups: the elevated RHR group with 166 patients’ resting heart rate above 80 times per minute, and the non-elevated RHR group with 104 patients’ resting heart rate equal or less than 80 times per minute.The general data, biochemical criterions and LVEF of these two group were compared to found out the influence of the elevated RHR on patients with CHF. Then adopted prospective study method and divided those patients into another two groups randomly according to whether to accept heart rate control:the heart rate control group with 55 to 65 times per minute’s heart rate control;the routine matched group without strengthening the heart rate. The medicine for heart rate control used β-blocker and added digoxin when necessary. The β-blocker was used from the small dose to the maximum or reached the target heart rate. The matched group also used β-blocker or digoxin, yet without strengthening the heart rate to the target heart rate. After half a year’s follow up, the heart rate control group contained 120 people and the matched group 118 people after withdrawing 23 patients lost and 9 patients death. This experiment discusses the influence of strengthening heart rate control on patients with CHF by comparing the heart structure and function、kidney function、readmission rate and mortality rate of the two groups.Results:1. The elevated RHR group and the non-elevated RHR group had no statistically significant difference among gender,age,smoking history, BMI,hypertension history,diabetes history(P> 0.05).2. The LVEF of the elevated RHR group was lower than the nonelevated RHR group(46.67±6.92% vs 48.76±6.87%,P<0.05),but the NT-pro BNP was higher than the non-elevated RHR group(3467.72± 3600.88ng/ml vs 2665.15±2974.91ng/ml,P<0.05). Those criterions which could reflect the myocardial cell damage contained c Tn I(0.0175±0.0046 vs 0.01624±0.0050,P<0.05),CK(168.48±87.29U/L vs 146.42±80.28 U/L,P<0.05)and CK-MB(19.87±8.45U/L vs 17.81±7.82U/L, P<0.05) were higher than the non-elevated RHR group. And the criterions which could reflect the renal function as Cre(119.11±73.57umol/l vs 104.16 ±50.86umol/l,P<0.05),UA( 428.04±123.13umol/l vs 393.91±114.44 umol/l,P<0.05)and Cys C(1.59±0.79mg/l vs 1.40±0.69 mg/l, P<0.05) were higher than the non-elevated RHR group. Above mentioned contrast had statistically significant.But the FPG, TC and TG had no statistically significant difference between them(P>0.05).3.The heart rate control group and the matched group had no statistically significant difference among gender,age,smoking history,BMI,hypertension history,diabetes history and average RHR(P> 0.05).4. The treatment effect of the heart rate control group was higher than the matched group(63.41% vs 50.81%,P<0.05).5. The contrast of LVEF,LEDV and LESV before and after heart rate controlled on the group of heart rate control were respectively(48.07±7.19% vs 52.32±6.64%,P<0.001),(143.46±12.97 ml vs 133.12± 13.97 ml,P<0.001)and(70.20±13.13 ml vs 60.62±10.67 ml, P<0.001). The contrast of LVEF,LEDV and LESV before and after heart rate controlled of the matched group were respectively(48.47±6.66 ml vs 50.36±7.83 ml,P<0.05),(142.14±17.26 ml vs 137.17±15.74 ml,P<0.05)and( 68.01±14.08 ml vs 64.03±10.89 ml,P<0.05). Above mentioned contrast had statistically significant.The contrast of LVEF,LEDV and LESV between two groups before heart rate controlled had no statistically significant,but after heart rate controlled they were respectively(52.32 ±6.64% vs 50.36±7.83%,P<0.05),(133.12±13.97 ml vs 137.17±15.74 ml, P<0.05)and(60.62±10.67 ml vs 64.03±10.89 ml,P<0.05).They difference had statistically significant.6. The contrast about Cre and Cys C before and after heart rate controlled on the group of heart rate control were respectively(103.13±63.40umol/L vs 80.31±31.88umol/L,P<0.001)and(1.41±0.76 mg/L vs 1.11±0.64mg/L,P<0.001). The contrast about Cre and Cys C before and after heart rate controlled of the matched group were respectively(110.79±69.63umol/L vs 93.18±62.99umol/L,P<0.05)and(1.53±0.89mg/L vs 1.31±0.83mg/L,P<0.05). Above mentioned contrast had statistically significant.The contrast between the two groups about Cre and Cys C before heart rate controlled had no statistically signi ficant, but after heart rate controlled they were respectively(80.31±31.88umol/L vs 93.18±62.99umol/L,P<0.05)and(1.11±0.64mg/L vs 1.31±0.83 mg/L, P<0.05), they diffrence had statistically significant.7.The readmission rate of the heart rate control group was lower than the matched group(5.83% vs13.56%, P<0.05).They had no statistically significant difference of the mortality rate( P>0.05).Conclusions:1. Elevated resting heart rate on patients with chronic heart failure may deteriorate cardiac function and renal function.2. It may better improve cardiac function,renal function and shortterm prognosis of the patients with chronic heart failure by strengthening heart rate control.