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Independent and incremental prognostic value of heart rate variability in patients with chronic heart failure

D Bonaduce1, M Petretta, F Marciano

  • 1Institute of Internal Medicine, University of Naples, Italy. bonaduce@unina.it

American Heart Journal
|July 30, 1999
PubMed

Insights

Heart rate variability (HRV) independently predicts cardiac death in chronic heart failure patients. HRV analysis improves risk stratification beyond clinical data, aiding in identifying high-risk individuals.

Area of Science:

  • Cardiology
  • Autonomic Nervous System Function
  • Heart Failure Research

Background:

  • Reduced heart rate variability (HRV) signifies impaired cardiac autonomic control in chronic heart failure (CHF).
  • The independent prognostic capability of HRV, compared to clinical factors and left ventricular dysfunction, requires further investigation.
  • This study aimed to assess the predictive value of HRV and Poincaré plots using 24-hour Holter monitoring in CHF patients.

Purpose of the Study:

  • To evaluate the prognostic value of heart rate variability (HRV) in patients with chronic heart failure.
  • To determine if HRV analysis provides incremental predictive information over established clinical and echocardiographic parameters.
  • To assess the additional predictive value of Poincaré plots derived from 24-hour Holter recordings.

Main Methods:

  • Ninety-seven patients with chronic heart failure (left ventricular ejection fraction ≤40%) underwent 24-hour Holter and echocardiographic assessments.
  • Etiologies of heart failure included coronary artery disease (59%) and idiopathic dilated cardiomyopathy (41%).
  • Cox multivariate analysis was employed to identify predictors of cardiac death during a mean follow-up of 39 months.

Main Results:

  • During follow-up, 32 cardiac deaths occurred.
  • Significant predictors of mortality included left ventricular end-systolic volume, low- to high-frequency ratio, percentage of differences between successive normal R-R intervals >50 ms, and age.
  • HRV analysis significantly improved the prognostic model (P <.001), whereas Poincaré plots did not add further predictive value.

Conclusions:

  • Heart rate variability (HRV) possesses independent and incremental prognostic value in patients with chronic heart failure.
  • HRV assessment is a valuable tool for stratifying patients at high risk of cardiac death.
  • While HRV is predictive, Poincaré plot analysis did not enhance risk stratification in this cohort.
Abstract

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