Prognostic Value of Heart Rate Variability in Chronic Congestive Heart Failure Secondary to Idiopathic or Ischemic Dilated Cardiomyopathy

Szabó, Balázs; Veldhuisen, Dirk J. van; Veer, N. van der; Brouwer, Jan; Graeff, Pieter A. de; Crijns, Harry J.G.M.

doi:10.1016/s0002-9149(97)00026-x

Cited by 129 publications

(67 citation statements)

References 6 publications

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“…Heart rate variability is a standardized tool for examining ANS activity in various disease states such as hypertension, diabetes mellitus, coronary artery disease, as well as myocardial dysfunction. Similar to studies post-myocardial infarction, CHF is characterized by a decrease in time-domain indices of HRV, which correlates with the severity of left ventricular dysfunction (2,(15)(16)(17).…”

Section: Discussionmentioning

confidence: 74%

“…Heart rate variability is known to be depressed in CHF (2) and depressed HRV predicts hemodynamic compromise, sudden death and death from progressive pump dysfunction (16,(18)(19)(20). SDNN has been shown to be strongly predictive of mortality in CHF; in the UK-HEART study, SDNN <50 ms was associated with >50% mortality compared to only 5.5% in the group with SDNN >100 ms (20).…”

Section: Discussionmentioning

confidence: 99%

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The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

Kocaman

Taçoy²,

Özdemir³

et al. 2010

Anadolu Kardiyol Derg

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Objective: Autonomic dysfunction is an important marker of prognosis in congestive heart failure (CHF) and may determine the symptoms and progression of CHF. The aim of our study was to investigate whether preserved autonomic function assessed by heart rate variability (HRV) analyses is related to absence of CHF symptoms despite prominently reduced systolic function. Methods: The study had a cross-sectional observational design. Fifty patients with left ventricular ejection fraction (EF) below 40% were enrolled. The patients were divided into two groups according to their CHF symptomatic status as Group 1 (NYHA functional class I, asymptomatic group) and Group 2 (NYHA functional class≥ II, symptomatic group). Plasma C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-proBNP) levels, echocardiographic parameters and HRV indices were measured while the patients were clinically stable in each group. Possible factors associated with the development of CHF symptoms were assessed by using multiple regression analysis. Results: Baseline clinical characteristics and left ventricular EF were similar in the two groups. Serum CRP (15±21 vs 7±18 mg/L, p=0.011) and NT-proBNP levels (1935±1088 vs 1249±1083 pg/mL, p=0.020) were significantly higher in symptomatic group. The HRV parameters (SDNN: 78±57 vs 122±42 ms, p=0.001; SDANN: 65±55 vs 84±38 ms, p=0.024; SDNNi: 36±41 vs 70±46 ms, p<0.001; triangular index [Ti]: 17±12 vs 32±14, p<0.001) were also significantly depressed in symptomatic group. When multiple regression analysis was performed, only HRV indices of autonomic function were significantly associated with the asymptomatic status (SDNN, OR: 1.016, 95%CI: 1.002-1.031, p=0.028; SDNNi, OR: 1.030, 95%CI: 1.008-1.052, p=0.006; TI, OR: 1.088, 95%CI: 1.019-1.161, p=0.011). Conclusion: Preserved autonomic functions were shown to be associated with absence of CHF symptoms independently of angiotensin converting enzyme inhibitor/angiotensin receptor blocker's treatment and BNP levels and may be protective against the development of CHF symptoms despite advanced left ventricular systolic dysfunction. (Anadolu Kardiyol Derg 2010 December 1; 10(6); 519-25) Key words: Heart rate variability, systolic heart failure, preserved autonomic function, autonomic dysfunction, clinical symptoms, regression analysis ÖZET Amaç: Otonomik disfonksiyon konjestif kalp yetersizliğinde (KKY) prognozun önemli bir belirleyicisidir ve KKY'nin semptomlarını ve ilerlemesini öngörebilir. Çalışmamızın amacı belirgin olarak azalmış sistolik fonksiyonu olan hastalarda kalp hızı değişkenliği (KHD) ile belirlenen korunmuş otonomik fonksiyonun KKY semptomlarının yokluğu ile ilişkili olup olmadığının araştırılmasıdır. Yöntemler: Çalışma gözlemsel ve enine-kesitli olarak planlandı. Sol ventrikül ejeksiyon fraksiyonu (EF) %40'ın altında 50 hasta çalışmaya alındı. Hastalar KKY semptomatik durumlarına göre; Grup 1 (NYHA sınıf I, asemptomatik grup) ve Grup 2 (NYHA sınıf>=II, semptomatik grup) olmak üzere iki gruba ayrıldılar. Hastaların p...

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

Kocaman

Taçoy²,

Özdemir³

et al. 2010

Anadolu Kardiyol Derg

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“…16 In patients with heart failure, lower pNN50 is an independent predictor of increased cardiac mortality. 17 The pNN50 is a subtle indicator of cardiac autonomic control and is thought to reflect mainly the vagal component of cardiac regulation 11,18 ; indeed, it is one of the earliest indicators of cardiac autonomic dysfunction. This has been demonstrated in patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Central Sleep Apnea in Left Ventricular Dysfunction

et al. 2003

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Background— The prevalence and characteristics of sleep-disordered breathing in patients with asymptomatic left ventricular (LV) dysfunction are unknown. Therefore, we evaluated the prevalence of sleep-disordered breathing in patients with LV dysfunction without overt heart failure and tested the hypothesis that sleep-disordered breathing is linked to greater hemodynamic and autonomic impairment. Methods and Results— We studied 47 patients with LV ejection fractions ≤40% without any history of heart failure. Central sleep apnea (CSA), as defined by an apnea-hypopnea index ≥15/h, was present in 26 patients (55%), 17 (36%) of whom had severe CSA (apnea-hypopnea index ≥30/h). Obstructive sleep apnea was evident in 5 patients (11%). The prevalence and severity of CSA were higher in patients with ischemic cardiomyopathy than in patients with nonischemic cardiomyopathy ( P <0.05). Exercise tolerance and echocardiographic indices of systolic and diastolic function were similar in patients without CSA, with mild CSA, and with severe CSA. Heart rate variability was markedly depressed in patients with CSA ( P <0.05). Patients with severe CSA also had a higher incidence of nonsustained ventricular tachycardia ( P =0.05). Conclusions— CSA is highly prevalent in patients with asymptomatic LV dysfunction. The severity of CSA may not be related to the severity of hemodynamic impairment. Severe CSA is associated with impaired cardiac autonomic control and with increased cardiac arrhythmias.

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“…17 However, both increased 18 and reduced 5 LF power were found to be associated with an increased risk of cardiac death. Recent data from Galinier et al 7 showed that reduced daytime LF power from 24-hour Holter recording independently and significantly predicted sudden death, although very few other parameters were included in the analysis.…”

Section: Prognostic Value Of Hrv In Chf Patientsmentioning

confidence: 99%

Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients

et al. 2003

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Background-The predictive value of heart rate variability (HRV) in chronic heart failure (CHF) has never been tested in a comprehensive multivariate model using short-term laboratory recordings designed to avoid the confounding effects of respiration and behavioral factors. Methods and Results-A multivariate survival model for the identification of sudden (presumably arrhythmic) death was developed with data from 202 consecutive patients referred between 1991 and 1995 with moderate to severe CHF (age 52Ϯ9 years, left ventricular ejection fraction 24Ϯ7%, New York Heart Association class 2.3Ϯ0.7; the derivation sample). Time-and frequency-domain HRV parameters obtained from an 8Ј recording of ECG at baseline and during controlled breathing (12 to 15 breaths/min) were challenged against clinical and functional parameters. This model was then validated in 242 consecutive patients referred between 1996 and 2001 (validation sample). In the derivation sample, sudden death was independently predicted by a model that included low-frequency power (LFP) of HRV during controlled breathing Յ13 ms 2 and left ventricular end-diastolic diameter Ն77 mm (relative risk [RR] 3.7, 95% CI 1.5 to 9.3, and RR 2.6, 95% CI 1.0 to 6.3, respectively). The derivation model was also a significant predictor in the validation sample (Pϭ0.04). In the validation sample, LFP Յ11 ms 2 during controlled breathing and Ն83 ventricular premature contractions per hour on Holter monitoring were both independent predictors of sudden death (RR 3.0, 95% CI 1.2 to 7.6, and RR 3.7, 95% CI 1.5 to 9.0, respectively). Conclusions-Reduced short-term LFP during controlled breathing is a powerful predictor of sudden death in patients withCHF that is independent of many other variables. These results refine the identification of patients who may benefit from prophylactic implantation of a cardiac defibrillator. (Circulation. 2003;107:565-570.)

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Prognostic Value of Heart Rate Variability in Chronic Congestive Heart Failure Secondary to Idiopathic or Ischemic Dilated Cardiomyopathy

Cited by 129 publications

References 6 publications

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

Central Sleep Apnea in Left Ventricular Dysfunction

Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients

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