Objective:
To evaluate the association of pressure-adjusted heart rate (PAHR) with survival in patients with severe aortic stenosis (AS).
Approach:
- Study Design: A retrospective cohort study of 14,409 adult patients with severe native aortic stenosis identified via transthoracic echocardiography from 2010 to 2020.
- PAHR Calculation: PAHR was calculated as heart rate × (right atrial pressure / mean arterial pressure) and patients were stratified into quartiles.
- Survival Analysis: Kaplan-Meier analyses and multivariable Cox proportional hazards models were used to assess the association between PAHR and all-cause mortality.
Key Findings:
- Higher PAHR quartiles were associated with progressively worse survival under medical management.
- Patients in the second, third, and fourth PAHR quartiles had 15%, 61%, and 151% higher adjusted risks of mortality compared to the lowest quartile.
- Baseline PAHR remained significantly associated with mortality following aortic valve replacement (AVR).
- Patients in the third and fourth PAHR quartiles had 34% and 89% higher adjusted risks of mortality post-AVR.
Interpretation:
PAHR may provide a simple, noninvasive estimate of overall hemodynamic burden in severe AS, offering complementary insight into patient risk before and after valve replacement.
Limitations:
- The study is retrospective and requires external validation.
- Prospective studies are needed to assess the incremental value of serial PAHR assessment.
Conclusion:
PAHR should be viewed as complementary to existing risk assessment approaches rather than a replacement.
Sources:
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