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Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease: The Stockholm
I Janszky1, M Ericson, M A Mittleman
1Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Insights
Low heart rate variability (HRV) predicts long-term mortality in middle-aged women after acute coronary events. This finding holds true even when accounting for established clinical risk factors.
Area of Science:
- Cardiology
- Medical Prognostics
Background:
- Low heart rate variability (HRV) is linked to poor outcomes after acute coronary events in men.
- The prognostic significance of HRV in women with coronary heart disease (CHD) is less understood.
Purpose of the Study:
- To evaluate the long-term predictive value of HRV for mortality in middle-aged women diagnosed with CHD.
- To assess if HRV parameters measured post-acute coronary syndrome can predict all-cause and cardiovascular mortality.
Main Methods:
- A cohort of women under 65 hospitalized for acute coronary syndrome were followed for a median of 9 years.
- Ambulatory 24-hour electrocardiography was performed 3-6 months post-hospitalization to assess HRV parameters (SDNN index, total power, HF, LF, VLF power, LF/HF ratio).
- Cox proportional hazards regression was used to determine hazard ratios for mortality associated with decreased HRV parameters.
Main Results:
- Several HRV parameters, including SDNN index, total power, VLF power, LF power, and HF power, were significant predictors of all-cause mortality after adjusting for clinical variables.
- These HRV parameters demonstrated similar predictive power for cardiovascular mortality.
- The predictive strength of HRV parameters was more pronounced within the first 5 years following the acute coronary event.
Conclusions:
- Reduced HRV is a significant predictor of long-term mortality in middle-aged women with CHD.
- This predictive capability of HRV is evident even when considering established clinical prognostic markers.
- HRV assessment 3-6 months after an acute coronary syndrome provides valuable prognostic information for women.
Objectives:
Low heart rate variability (HRV) is associated with poor prognosis after acute coronary events in men. In women, the prognostic impact is not well documented. The objective of this study was to assess the long-term predictive power of HRV on mortality amongst middle-aged women with coronary heart disease (CHD). DESIGN, SETTINGS AND SUBJECTS: Consecutive women below 65 years hospitalized for an acute coronary syndrome during a 3-year period in Stockholm were examined for cardiovascular prognostic factors including HRV, and followed for a median of 9 years. An ambulatory 24-h electrocardiograph was recorded during normal activities, 3-6 months after hospitalization. SDNN index (mean of the standard deviations of all normal to normal intervals for all 5-min segments of the entire recording) and the following frequency domain parameters were assessed: total power, high-frequency (HF) power, low-frequency (LF) power, very-low frequency (VLF) power and LF/HF ratio. Using Cox proportional hazards regression, the hazard ratios (HR) for each 25% decrease of the HRV parameters were assessed.
Results:
After controlling for the independent, significant predictors of mortality amongst the clinical variables, the following HRV parameters were found to be significant predictors of all-cause mortality: SDNN index [HR 1.56, 95% confidence intervals (CI) 1.19-2.05], total power (HR 1.21, 95% CI 1.08-1.35), VLF power (HR 1.22, 95% CI 1.09-1.36), LF power (HR 1.18 95%, CI 1.07-1.30) and HF power (HR 1.18, 95% CI 1.05-1.33). The results were essentially the same when cardiovascular mortality was used as end-points. The HRV parameters were stronger predictors of mortality in the first 5 years following the index event.
Conclusion:
Low HRV is a predictor of long-term mortality amongst middle-aged women with CHD when measured 3-6 months after hospitalization for an acute coronary syndrome, even after controlling for established clinical prognostic markers.
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