Prognostic Value of Heart Rate Variability in Patients Awaiting Cardiac Transplantation

Abstract

Time and frequency domain parameters of heart rate variability (HRV) were determined in patients with severe endstage heart failure awaiting cardiac transplantation (HTX). These parameters were then correlated with mortality to investigate the performance of HRV in discriminating between groups with high and low risk of death. The standard deviation of five consecutive RR intervals (SDANN) was found to be the parameter with the greatest sensitivity (90%) and specificity (91%). Patients with SDANN values of < 55 msec had a twenty-fold increased risk of death (90% confidence limits: 4-118, P < 0.001). The results furthermore suggest that measurements of HRV are superior to other prognostic markers such as left ventricular ejection fraction, pulmonary artery wedge pressure, cardiac index, and serum sodium levels. We conclude that HRV is a powerful, noninvasive tool to assess the risk of death in candidates for HTX. HRV measurements can therefore be used as a supplement to other markers of risk to determine the optimal therapeutic strategy in patients with severe congestive heart failure.

Prognostic factors in patients with congestive heart failure

“…Despite the small number of patients in the series, the largest consisting of 102 patients 153 , the results have been consistent. Binder et al 152 , studying patients awaiting heart transplantation, observed that those with SDANN (an index of HRV in the time domain) of 55 ms had a 20-time increase in the risk of death. The authors suggest that HRV is superior to other prognostic factors, such as EF, pulmonary capillary pressure, cardiac index, and serum sodium.…”

“…In the last five years, HRV has been shown to of important prognostic value in CHF 149,[152][153][154] . Despite the small number of patients in the series, the largest consisting of 102 patients 153 , the results have been consistent.…”

Holter Monitoring of Small Breed Dogs with Advanced Myxomatous Mitral Valve Disease with and without a History of Syncope

“…Ultra low frequency (ULF) and very low frequency (VLF) are less understood, but are influenced by thermoregulation, physical activity, and the renin‐angiotensin system 18, 23, 24. Decreased HRV has been associated with an increased risk of death in dogs with experimentally induced myocardial infarction and in people with various cardiac diseases 25, 26, 27, 28, 29. Thus, both syncope and decreased HRV are associated with increased risk of death and therefore a history of syncope may be associated with decreased HRV in dogs with MMVD.…”

Implantable Sensors for Heart Failure

“…Similarly, cardiac autonomic tone as measured by short-term heart rate variability (HRV) is a powerful predictor of sudden cardiac death and total mortality in patients with chronic HF. 8,9 HRV can be measured from CIEDs with atrial leads by determining the standard deviation of 5-minute median atrial-atrial intervals (SDAAM) or consecutive ventricular (N-N) intervals (SDANN) over a 24-hour period. Periods of atrial pacing or high atrial rate episodes, including atrial fibrillation, are excluded from HRV analysis.…”