Relation of Short-Term Heart Rate Variability to Incident Heart Failure (from the Multi-Ethnic Study of Atherosclerosis)

Abstract

Whether autonomic dysfunction predates the development of symptomatic heart failure (HF), or is simply a consequence of severe HF, is unknown. We hypothesized that reduced heart rate variability (HRV, a marker of abnormal autonomic function) at baseline is associated with incident HF in individuals free of clinically recognized cardiovascular disease. In the Multi- Ethnic Study of Atherosclerosis (MESA), a community-based study of subclinical cardiovascular disease in adults age 45–84 years, we measured HRV using a standard 30-second 12-lead electrocardiogram to measure the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences in R-R intervals (RMSSD). During a median follow-up of 7.6 years, 95 participants developed HF (incidence rate, 2.7/1000 person-years). After adjusting for age, sex, and ethnicity, hazard ratios for incident HF by RMSSD tertile were 2.4 (95% confidence interval [CI] 1.4–4.2) for the lowest tertile and 1.7 (95% CI 1.0–3.2) for the middle tertile (highest tertile = referent group; P for trend<0.001). The inverse association between RMSSD and incident HF persisted after adjustment for additional covariates, including diabetes, systolic blood pressure, heart rate, subclinical atherosclerosis, left ventricular endsystolic volume, interim myocardial infarction, and high sensitivity C-reactive protein (P for trend=0.009). A similarly significant inverse association was also observed for SDNN. In conclusion, baseline autonomic dysfunction is risk factor for the development of HF in a multiethnic cohort. These population-based findings implicate autonomic dysfunction in the pathogenesis of HF, and decreased short-term HRV may be a novel form of Stage B (asymptomatic) HF.

Autonomic cardiocirculatory control in mice with reduced expression of the vesicular acetylcholine transporter

“…These data agree with observations that autonomic imbalance in mice with cholinergic dysfunction leads to cardiovascular alterations, which culminate in decreased cardiac function (31,60,63). Of note, clinical studies have demonstrated that reduced HR variability, as determined by SDNN and RMSSD, was independently associated with cardiovascular complications, even in patients free of clinically recognized cardiovascular disease (39,68). Moreover, low HR variability predicts poor prognosis and high relative risk of mortality in patients with myocardial infarction or heart failure (9,27,45).…”

Parameters of Autonomic Nervous System Dysfunction in Acute and Chronic Forms of Ischemic Heart Disease

“…Discussion. Analyzing frequency and spectral parameters of ECG R-R intervals at rest, statistically significant changes are noted in SDNN, RMSSD in both groups with IHD, which is in compliance with a classical picture [1][2][3]: in acute and chronic forms of IHD HRV decreases. Decrease of general HRV (shown by SDNN) coincides with the reduction of the total spectral power TP and the power of all TP components including a highfrequency constituent HF.…”

“…Alterations of cardiac cycle from contraction to contraction are considered to reflect the balance between sympathetic and parasympathetic influences on the heart, the latter being assigned a cardioprotective role [1]. Acute myocardial infarction (AMI), unstable angina are the most studied forms of ischemic heart disease (IHD), in which evidence of HRV interrelation with clinical prognosis of both sudden death [2] and progression of chronic heart failure has been obtained [3].…”

Cardiovascular magnetic resonance imaging and clinical performance of somatostatin receptor positron emission tomography in cardiac sarcoidosis

“…Holter ECG data were analysed for conduction block occurrence, as well as supraventricular and ventricular arrhythmic burden. Moreover, we examined heart rate variability as an established predictor of increased mortality and elevated risk of cardiac events in the general population 14. T‐wave alternans that displays heterogeneity in ventricular repolarization and thus predicts ventricular arrhythmias in patients at risk for sudden cardiac death was additionally registered 15.…”