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Heart rate variability in heart failure
Agata Musialik-Łydka1, Beata Sredniawa, Stanisław Pasyk
1Department of Cardiology, Silesian Medical Academy, Silesian Centre for Heart Diseases, Zabrze, Poland.
Insights
Heart rate variability (HRV) is significantly reduced in patients with heart failure (CHF). Lower HRV indicates increased risk, particularly in those with diabetes, hypertension, or ventricular tachycardia.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Medical Diagnostics
Background:
- Heart rate variability (HRV) reflects autonomic nervous system function and its impact on the sinus node.
- HRV analysis is increasingly used in heart failure (CHF) patients to predict cardiac death risk.
Purpose of the Study:
- To analyze HRV in CHF patients with reduced left ventricular ejection fraction (EF).
- To correlate HRV parameters with EF, NYHA functional class, and other clinical factors.
Main Methods:
- 105 CHF patients (NYHA class II-IV, EF <40%) and 30 healthy controls underwent 24-hour Holter ECG for HRV analysis.
- Patients included ischaemic and dilated cardiomyopathy; controls were age- and gender-matched.
Main Results:
- CHF patients exhibited significantly lower HRV than controls.
- Lower HRV (SDNN, SDANN) correlated with higher NYHA class, lower EF, and presence of ventricular tachycardia (VT).
- Diabetes and hypertension were associated with reduced HRV (SDNN, rMSSD).
Conclusions:
- HRV is depressed in CHF patients compared to healthy individuals.
- Advanced NYHA class, lower EF, diabetes, hypertension, and VT further decrease HRV in CHF patients.
Background:
Heart rate variability (HRV) depicts the functional status of the autonomic nervous system and its effects on sinus node. Recently, HRV analysis has been introduced in patients with heart failure (CHF) to identify those who are at risk of cardiac death.
Aim:
To analyse HRV in patients with CHF with depressed left ventricular ejection fraction (EF) and to relate HRV parameters to EF, NYHA functional class and other clinical parameters.
Methods:
The study group consisted of 105 patients with CHF (88 males, 17 females, mean age 54+/-12 years); 77 patients had ischaemic cardiomyopathy, and 28 - dilated cardiomyopathy. All patients were in NYHA class II-IV and had EF <40%. The mean value of echocardiographically assessed EF was 26.9+/-8.3%. The control group consisted of 30 gender- and age-matched healthy subjects. HRV analysis was performed in the time-domain from 24-hour Holter ECG.
Results:
All HRV variables were significantly lower in patients with CHF than in controls. Patients with NYHA class II had higher values of SDNN and SDANN than those in class III or IV. Patients with sustained or non-sustained ventricular tachycardia (VT) detected during Holter monitoring had lower SDNN and SDANN values than those without VT. Patients with diabetes had significantly lower SDNN and rMSSD values than the patients without diabetes. Similar results were found when patients with or without hypertension were compared. HRV parameters were similar in patients either with ischaemic or dilated cardiomyopathy. Also the values of EF were similar (27.4+/-8.4 vs 25.0+/-8.3%, respectively, NS). In the whole group of patients with CHF the values of SDNN and SDANN significantly correlated with EF (SDNN p<0.001, r=0.42; SDANN p<0.001, r=0.51). This correlation was stronger in the subset of patients with ischaemic cardiomyopathy (SDNN p=0.002. r=0.54; SDANN p=0.002; r=0.53) than in those with dilated cardiomyopathy (SDNN p=0.012, r=0.23; SDANN p=0.008, r=0.42). A significant negative correlation was found between all HRV parameters and NYHA class (SDNN p<0.001, r = -0.33; SDANN p<0.001, r = -0.38; rMSSD p<0.001, r = -0.13).
Conclusions:
HRV is depressed in patients with CHF compared with healthy subjects. Among patients with CHF, HRV is further decreased in patients with more advanced NYHA class, lower EF and in those with diabetes, hypertension or VT on Holter monitoring.
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