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[Nonischemic dilated cardiomyopathy. Parameters of autonomic tone]
Thomas Demming1, Sarah Sandrock, Hendrik Bonnemeier
1Klinik für Innere Medizin III für Kardiologie und Angiologie, Abteilung für Elektrophysiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, A. Heller Straße 3, 24105, Kiel, Deutschland, thomas.demming@uksh.de.
Insights
Innovative heart rate variability (HRV) parameters show promise for predicting sudden cardiac death risk in nonischemic dilated cardiomyopathy (DCM) patients. Further research is needed to integrate these autonomic tone markers into clinical practice.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
Context:
- Nonischemic dilated cardiomyopathy (DCM) is a leading cause of heart failure.
- Current risk stratification using left ventricular ejection fraction is insufficient for DCM patients.
- Autonomic dysfunction plays a role in heart failure prognosis.
Purpose:
- To evaluate the prognostic relevance of autonomic tone parameters in nonischemic dilated cardiomyopathy (DCM).
- To explore the utility of innovative heart rate variability (HRV) measures beyond classical parameters.
- To identify the need for improved risk assessment tools for sudden cardiac death in DCM.
Summary:
- Classical heart rate variability (HRV) parameters yield inconsistent data in DCM patients due to varied methodologies.
- Innovative HRV parameters and other autonomic tone measures demonstrate potential prognostic value in DCM.
- Limited patient numbers and lack of prospective data necessitate further investigation.
Impact:
- Highlights the need for advanced autonomic assessment in DCM patient management.
- Suggests that innovative HRV parameters could improve sudden cardiac death risk stratification.
- Emphasizes the gap between research findings and clinical integration of autonomic markers.
Background:
Nonischemic dilated cardiomyopathies (DCM) are the most common reason for heart failure in developed countries after ischemic disease. They often lead to device therapy. Left ventricular ejection fraction as a single parameter to identify patients at risk for sudden cardiac death revealed inconclusive data in patients with DCM.
Methods:
Autonomic tone, measured by classical and innovative parameters of heart rate variability (HRV), heart rate turbulence or baroreceptor reflex, was demonstrated to give valuable prognostic information especially in patients with ischemic disease and after acute myocardial infarction. In patients with DCM, classical parameters of HRV showed inhomogeneous data in a heterogeneous patient collective caused by unsystematic measurement of single parameters in various patient collectives.
Results:
Innovative parameters of HRV are promising in patients with DCM and showed prognostic relevance although patient numbers are limited and prospective data are missing. Further studies are needed in this field.
Conclusion:
Despite the in part convincing evidence for the relevance of autonomic tone as a prognostic marker in patients with DCM, their evaluation is still not part of clinical routine. Additional parameters to estimate the risk of sudden cardiac death are urgently needed.
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