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Herzfrequenz und Frequenzkontrolle

Prognostische Bedeutung bei kardiovaskulären Erkrankungen

Heart rate and rate control

Prognostic value in cardiovascular diseases

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Zusammenfassung

Die Herzfrequenz ist ein kardiovaskulärer Risikoindikator. Insbesondere bei Patienten mit Herzinsuffizienz und möglicherweise auch bei koronarer Herzerkrankung ist eine erhöhte Ruhe-Herzfrequenz als unabhängiger Risikofaktor anzusehen. Klinische und experimentelle Arbeiten weisen darauf hin, dass die Herzfrequenz selbst direkte Wirkungen auf strukturelle und funktionelle Eigenschaften des Herz-Kreislauf-Systems, v. a. auf das Gefäßsystem, ausübt. Die Daten der SHIFT-Studie belegen den Stellenwert der Herzfrequenz als Risikofaktor und Therapieansatz bei Patienten mit chronischer Herzinsuffizienz: Zusätzlich zu einer leitliniengerechten medikamentösen Therapie reduzierte Ivabradin die Häufigkeit von Klinikeinweisungen aufgrund einer klinischen Verschlechterung und reduzierte zudem herzinsuffizienzbedingte Todesfälle. Die Daten der BEAUTIFUL-Studie zeigen, dass eine Herzfrequenz von ≥70 Schlägen pro Minute bei Patienten mit einer ischämischen Kardiomyopathie das Risiko für koronare Ereignisse erhöht.

Abstract

Resting heart rate represents a cardiovascular risk indicator and an important target of therapy in chronic heart failure and potentially in coronary artery disease. Clinical and experimental evidence suggests that sustained elevation of heart rate – independent of the underlying trigger – plays a causal role in the pathogenesis of vascular disease. Results of the SHIFT trial support the importance of heart-rate reduction with ivabradine for improvement of clinical outcomes in heart failure and confirm the role of heart rate as a risk factor for patients with severe left ventricular dysfunction. Results of the BEAUTIFUL trial show that patients with ischemic heart disease and a heart rate above 70 bpm exhibit an adverse prognosis concerning coronary events.

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Interessenkonflikt

Der korrespondierende Autor gibt an, dass für ihn kein Interessenkonflikt besteht, und weist auf folgende Beziehungen hin:

Prof. Böhm ist Mitglied des Exekutiv Komitees der SHIFT-Studie und erhielt Vortragshonorare von Servier. Die Universität des Saarlandes erhielt Forschungsgelder von Servier.

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Authors and Affiliations

  1. Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland

    F. Custodis, J.-C. Reil, U. Laufs & M. Böhm

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  1. F. Custodis
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  2. J.-C. Reil
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  3. U. Laufs
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  4. M. Böhm
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Correspondence to F. Custodis.

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Custodis, F., Reil, JC., Laufs, U. et al. Herzfrequenz und Frequenzkontrolle. Internist 53, 6–13 (2012). https://doi.org/10.1007/s00108-011-2887-3

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