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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
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.
Background:
Decreased heart rate variability (HRV), indicating derangement in cardiac autonomic control, has been reported in patients with chronic heart failure. However, the independent and incremental prognostic value of HRV over clinical data and measures of left ventricular dysfunction has been less thoroughly investigated. This study was designed to evaluate the predictive value of HRV and Poincaré plots as assessed by 24-hour Holter recording in patients with chronic heart failure.
Methods:
Ninety-seven patients, mean age 55 +/- 13 years, with radionuclide left ventricular ejection fraction
Results:
During follow-up (39 +/- 18 months), 32 cardiac deaths occurred. By Cox multivariate analysis, significant predictors of death were left ventricular end-systolic volume (hazard ratio 1.04), low- to high-frequency ratio (hazard ratio 0.09), percentage of differences between successive normal R-R intervals >50 ms (hazard ratio 0.93), and age (hazard ratio 1.06). Furthermore, HRV analysis improved (P <. 001) the prognostic power of a model including clinical and echocardiographic data, left ventricular ejection fraction, and ventricular arrhythmias at Holter recording, whereas the inclusion of Poincaré plots did not add further predictive value.
Conclusions:
Our investigation demonstrated that HRV has independent and incremental prognostic value in patients with chronic heart failure and seems useful to stratify patients at high risk of cardiac death.