The significance of rate pressure product in heart failure patients

Abstract

<p><span>Introduction: </span>The rate pressure product (RPP) is a strong determinant of myocardial oxygen consumption, and relates strongly to important indices for morbidity and cardiovascular mortality. Its significance in Black-African subjects with heart failure (HF) has however not been well described. This study therefore aimed to assess the significance of RPP among admitted HF patients in 2 Nigerian centres.</p><p><span>Methods: </span>Admitted HF patients in the 2 centres were serially recruited after satisfying all inclusion criteria. RPP was calculated by multiplying heart rate by systolic blood pressure at admission. Subjects were classified into 2 groups based on RPP <10,000 (log10 <4.0) (group 1) or above (group 2), which is a cut-off value above which there is increased risk of myocardial ischemia.</p><p><span>Results: </span>100 subjects were recruited from the 2 centres with a mean age of 47.3+/-19.5 years, and 53% were females. 35% of the subjects were in group 1 while 65% were in group 2. N-Terminal B-type Natriuretic Peptide (NTBNP), serially measured in only 37 subjects (12 in group 1; 25 in group 2), was significantly higher in group 1 as compared with group 2 (p=0.016). Group 1 also had lower interventricular septal thickness(IVST) (p=0.007) as compared with group 2 subjects. RPP correlated strongly with IVST (r=+0.510, p<0.001), left ventricular posterior wall thickness (LVPWT) (r=+0.399, p<0.001) and LV end-diastolic dimension (LVEDD) (r=-0.202, p=0.045). Log10 >4.0 was strongly associated with IVST (95%confidence interval (CI): 1.061-1.528, p=0.009) and NT-BNP (CI:0.999-1.000, p=0.026). There was however no significant relationship (p>0.05) between RPP and in-hospital mortality, severity of dyspnoea, gender, age, body weight, LV ejection fraction or presence of atrial fibrillation/flutter.</p><p><span>Conclusion: </span>This study confirms the close relationship that exists between a determinant of myocardial oxygen consumption (RPP), and indices for LV wall tension (IVST, LVEDD and NT-BNP), in Black-Africans with HF.</p>

Comparison Between 6 Minutes Walking Distance (6MWD), Changes in Rate Pressure Product (RPP) and Heart Rate Walking Speed Index (HRWSI) of 6 Minutes Walk Test (6MWT) Pre-Discharge as a Predictor Major Adverse Cardiac Event (MACE) in Patients with Acute Heart Failure

“…This research is different from the study conducted by Karaye et al (2015), where RPP is not associated with hospital mortality but is strongly associated with interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), and NT-BNP, which are risk factors for MACE events. [36].…”

Influence of Systolic Blood Pressure on Outcomes in Nigerians with Peripartum Cardiomyopathy

“…[32] In the present study, we found a prevalence of high RPP of 59.9%, which is similar to the value we previously found (65%) in HF patients with various etiologies including PPCM. [20] In both studies, however, it was not associated with poor clinical outcomes.…”

“…High RPP was defined as values >10,000. [20] Electrocardiography and echocardiography were carried out on each subject using standard criteria and methods. [21,22] The patients were re-evaluated at three-monthly interval and echocardiogram repeated six monthly to assess for the presence and extent of ventricular myocardial remodeling and changes in the size of the cardiac chambers.…”

Rate-Pressure Product is a Novel Predictor for Short- and Long-Term Mortality in Patients with Acute Coronary Syndrome Undergoing Primary PCI/Immediate Invasive Strategy

“… 6 The RPP, defined as heart rate multiplied by blood pressure, is a convenient and simple reference index to indirectly reflect cardiac work load and myocardial oxygen consumption and it relates strongly to important indices for cardiovascular morbidity and mortality in patients with myocardial ischemia. In the study by Karaye KM, 9 there was a close relationship between RPP and heart failure with indices for LV wall tension including interventricular septal thickness, LV end-diastolic dimension and N-terminal B-type natriuretic peptide level. Development of heart failure leads to hemodynamics disturbance and excessive sympathetic activity.…”

“… 6 , 7 RPP is strongly related with cardiovascular risk in hypertension patients 8 and has a close relationship with heart failure patients. 9 For coronary artery disease (CAD) patients, RPP is associated with myocardial perfusion imaging findings using gated single photon emission computed tomography imaging with dipyridamole stress and the occurrence of ischemic events has been shown to be related closely to increases in the RPP. 8 , 10 However, the usefulness of RPP in risk stratification for occurrence of short- and long-term mortality, has not been established in ACS patients undergoing primary PCI, which is the subject of the present study.…”