Associação entre a frequência cardíaca de repouso com a frequência cardíaca média no Holter 24h em pacientes com insuficiência cardíaca com fração de ejeção reduzida e ritmo sinusal

Abstract

Background: The importance of heart rate (HR) in heart failure with reduced ejection fraction (HFrEF) and sinus rhythm is well-recognised, but the optimal method for measurement remains debated. Objectives: To compare HR via resting ECG and 24-hour Holter monitoring in patients with HFrEF and sinus rhythm. Methods: This was a cross-sectional study of 135 patients, which included patients over 18 years of age, with heart failure with ejection fraction - 40% and sinus rhythm. HR assessed by resting ECG and 24-hour Holter monitoring. Analyzes included Intraclass Correlation Coefficient (ICC), Linear Regression and ROC curve. Results: The population had median [IQR] ages of 65 years [16], left ventricular ejection fraction 30% [11], and NT-pro-BNP of 1,345 pg/mL [2,348.2]. The ICC was 0.922 (95% CI: 0.892; 0.942). Linear Regression coefficients for ECG1 and ECG3 were 0.18 (95% CI: 0.11; 0.25) and 0.33 (95% CI: 0.20; 0.47), respectively. The R² was 0.626 (95% CI: 0.577; 0.684). The AUC of the ROC curve was 0.896 (95% CI: 0.865; 0.923), with an accuracy of 0.837 (95% CI: 0.836; 0.838). We observed an agreement of 63.8% (95% CI: 55.3; 71.6) at heart rates below 70 beats per min and 89.4% (95% CI: 85.6; 92.8) for values equal to or higher than 70 beats per min. Conclusion: Resting ECG-derived HR showed high concordance with 24-hour Holter HR, validating its clinical use in patients with HFrEF and sinus rhythm. However, agreement is suboptimal by one third in patients with resting HR < 70 beats per min, where more intensive treatment with HR-lowering medications could be used. [resumo fornecido pelo autor]