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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Cardiovascular Disorders 1/2018

Heart rate in patients with reduced ejection fraction: relationship between single time point measurement and mean heart rate on prolonged implantable cardioverter defibrillator monitoring

BMC Cardiovascular Disorders > Ausgabe 1/2018
Marlena V. Habal, Kumaraswamy Nanthakumar, Peter C. Austin, Cassandra Freitas, Christopher Labos, Douglas S. Lee
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12872-018-0751-2) contains supplementary material, which is available to authorized users.



Heart rate (HR) is a prognostic marker that is increasingly used as a therapeutic target in patients with cardiovascular disease. The association between resting and mean HR remains unclear. We therefore set out to determine the relationship between resting HR on the electrocardiogram (ECG) obtained at a single time point, and mean HR on implantable cardioverter defibrillator (ICD) interrogation amongst patients with a reduced left ventricular ejection fraction (LVEF).


Prospective ICD data were obtained from 54 patients with LVEF < 40%. Mean HR determined using the ICD HR histograms was compared with resting HR measured on the ECG performed in the clinic.


Average resting and ICD mean HRs were 67.9 ± 10.1 and 67.8 ± 9.6 bpm respectively. There was good correlation in the overall cohort (r = 0.79), in those with resting ECG HRs ≤ 70 bpm (r = 0.62), and amongst the 27 patients on intermediate-to-high dose beta-blockers (r = 0.91). However, Bland-Altman analysis demonstrated wide limits of agreement in the overall cohort (− 12.5, 12.7 bpm), at resting HRs ≤ 70 bpm (− 12.7, 9.8 bpm), and on intermediate-to-high dose beta-blockers (− 8.9, 7.4 bpm). Moreover, resting HR did not predict the 10-bpm interval where the most time was spent.


While resting HR correlated with mean HR in patients with reduced LVEF, and in important subgroups, the limits of agreement were unacceptably wide raising concern over the use of single time point resting HR as a therapeutic target.
Additional file 1: Figure S1. Mean HR determination from the device histogram. HR, heart rate. (TIFF 159 kb)
Additional file 2: Figure S2. Bland-Altman analysis for the overall cohort with limits of agreement set to ±5 bpm from the bias. (TIFF 294 kb)
Additional file 3: Table S1. Correlation and agreement between single time point and ICD heart rate in the unpaced, paced, and CRT paced subgroups. (DOCX 14 kb)
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