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Circulation, Vol 85, 164-171, Copyright © 1992 by American Heart Association
JT Bigger Jr, JL Fleiss, RC Steinman, LM Rolnitzky, RE Kleiger and JN Rottman
BACKGROUND. We studied 715 patients 2 weeks after myocardial infarction to
establish the associations between six frequency domain measures of heart
period variability (HPV) and mortality during 4 years of follow- up.
METHODS AND RESULTS. Each measure of HPV had a significant and at least
moderately strong univariate association with all-cause mortality, cardiac
death, and arrhythmic death. Power in the lower- frequency bands--ultra low
frequency (ULF) and very low frequency (VLF) power--had stronger
associations with all three mortality end points than power in the
higher-frequency bands--low frequency (LF) and high frequency (HF) power.
The 24-hour total power also had a significant and strong association with
all three mortality end points. VLF power was the only variable that was
more strongly associated with arrhythmic death than with cardiac death or
all-cause mortality. In multivariate Cox regression models using a step-up
approach to evaluate the independent associations between frequency domain
measures of heart period variability and death of all causes, ULF power was
selected first (i.e., was the single component with the strongest
association). Adding VLF or LF power to the Cox regression model
significantly improved the prediction of outcome. With both ULF and VLF
power in the Cox regression model, the addition of the other two
components, LF and HF power, singly or together, did not significantly
improve the prediction of all-cause mortality. We explored the relation
between the heart period variability measures and all-cause mortality,
cardiac death, and arrhythmic death before and after adjusting for five
previously established postinfarction risk predictors: age, New York Heart
Association functional class, rales in the coronary care unit, left
ventricular ejection fraction, and ventricular arrhythmias detected in a
24-hour Holter ECG recording. CONCLUSIONS. After adjustment for the five
risk predictors, the association between mortality and total, ULF, and VLF
power remained significant and strong, whereas LF and HF power were only
moderately strongly associated with mortality. The tendency for VLF power
to be more strongly associated with arrhythmic death than with all-cause or
cardiac death was still evident after adjusting for the five covariates.
Adding measures of HPV to previously known predictors of risk after
myocardial infarction identifies small subgroups with a 2.5- year mortality
risk of approximately 50%.
ARTICLES
Frequency domain measures of heart period variability and mortality after myocardial infarction
Department of Medicine, School of Public Health, Columbia University, New York, N.Y. 10032.
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A. R. Schwartz, W. Gerin, K. W. Davidson, T. G. Pickering, J. F. Brosschot, J. F. Thayer, N. Christenfeld, and W. Linden Toward a Causal Model of Cardiovascular Responses to Stress and the Development of Cardiovascular Disease Psychosom Med, January 1, 2003; 65(1): 22 - 35. [Abstract] [Full Text] [PDF]
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 J. Sahl, G. Mezei, R. Kavet, A. McMillan, A. Silvers, A. Sastre, and L. Kheifets Occupational Magnetic Field Exposure and Cardiovascular Mortality in a Cohort of Electric Utility Workers Am. J. Epidemiol., November 15, 2002; 156(10): 913 - 918. [Abstract] [Full Text] [PDF]
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C. H. Davos, P. A. Davlouros, R. Wensel, D. Francis, L. C. Davies, P. J. Kilner, A. J. S. Coats, M. Piepoli, and M. A. Gatzoulis Global Impairment of Cardiac Autonomic Nervous Activity Late After Repair of Tetralogy of Fallot Circulation, September 24, 2002; 106(12_suppl_1): I-69 - I-75. [Abstract] [Full Text] [PDF]
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G. Nollo, L. Faes, A. Porta, B. Pellegrini, F. Ravelli, M. Del Greco, M. Disertori, and R. Antolini Evidence of unbalanced regulatory mechanism of heart rate and systolic pressure after acute myocardial infarction Am J Physiol Heart Circ Physiol, September 1, 2002; 283(3): H1200 - H1207. [Abstract] [Full Text] [PDF]
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 R. Lampert, S. J. Baron, C. A. McPherson, and F. A. Lee Heart Rate Variability During the Week of September 11, 2001 JAMA, August 7, 2002; 288(5): 575 - 575. [Full Text] [PDF]
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M. A Cohen and J A. Taylor Short-term cardiovascular oscillations in man: measuring and modelling the physiologies J. Physiol., August 1, 2002; 542(3): 669 - 683. [Abstract] [Full Text] [PDF]
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 R Ferrara, F Mastrorilli, G Pasanisi, S Censi, N D'aiello, A Fucili, M Valgimigli, and R Ferrari Neurohormonal modulation in chronic heart failure Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D3 - D11. [Abstract] [PDF]
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G. E. Billman Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention J Appl Physiol, February 1, 2002; 92(2): 446 - 454. [Abstract] [Full Text] [PDF]
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J. J. Bailey, A. S. Berson, H. Handelsman, and M. Hodges Utility of current risk stratification tests for predicting major arrhythmic events after myocardial infarction J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1902 - 1911. [Abstract] [Full Text] [PDF]
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 J.-i. Hayano, S. Mukai, H. Fukuta, S. Sakata, N. Ohte, and G. Kimura Postural Response of Low-Frequency Component of Heart Rate Variability Is an Increased Risk for Mortality in Patients With Coronary Artery Disease Chest, December 1, 2001; 120(6): 1942 - 1952. [Abstract] [Full Text] [PDF]
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 H. V. Huikuri, A. Castellanos, and R. J. Myerburg Sudden Death Due to Cardiac Arrhythmias N. Engl. J. Med., November 15, 2001; 345(20): 1473 - 1482. [Full Text] [PDF]
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R. M. Carney, J. A. Blumenthal, P. K. Stein, L. Watkins, D. Catellier, L. F. Berkman, S. M. Czajkowski, C. O'Connor, P. H. Stone, and K. E. Freedland Depression, Heart Rate Variability, and Acute Myocardial Infarction Circulation, October 23, 2001; 104(17): 2024 - 2028. [Abstract] [Full Text] [PDF]
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 J. Gerritsen, J. M. Dekker, B. J. TenVoorde, P. J. Kostense, R. J. Heine, L. M. Bouter, R. M. Heethaar, and C. D.A. Stehouwer Impaired Autonomic Function Is Associated With Increased Mortality, Especially in Subjects With Diabetes, Hypertension, or a History of Cardiovascular Disease: The Hoorn Study Diabetes Care, October 1, 2001; 24(10): 1793 - 1798. [Abstract] [Full Text] [PDF]
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 K. Sevre, J. D. Lefrandt, G. Nordby, I. Os, M. Mulder, R. O. B. Gans, M. Rostrup, and A. J. Smit Autonomic Function in Hypertensive and Normotensive Subjects : The Importance of Gender Hypertension, June 1, 2001; 37(6): 1351 - 1356. [Abstract] [Full Text] [PDF]
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 N. TAKABATAKE, H. NAKAMURA, O. MINAMIHABA, M. INAGE, S. INOUE, S. KAGAYA, M. YAMAKI, and H. TOMOIKE A Novel Pathophysiologic Phenomenon in Cachexic Patients with Chronic Obstructive Pulmonary Disease . The Relationship between the Circadian Rhythm of Circulating Leptin and the Very Low-Frequency Component of Heart Rate Variability Am. J. Respir. Crit. Care Med., May 1, 2001; 163(6): 1314 - 1319. [Abstract] [Full Text]
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 C. M Albert and J. N Ruskin Risk stratifiers for sudden cardiac death (SCD) in the community: primary prevention of SCD Cardiovasc Res, May 1, 2001; 50(2): 186 - 196. [Full Text] [PDF]
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F. Lombardi, T. H Makikallio, R. J Myerburg, and H. V Huikuri Sudden cardiac death: role of heart rate variability to identify patients at risk Cardiovasc Res, May 1, 2001; 50(2): 210 - 217. [Full Text] [PDF]
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 W.S. Tunnicliffe, M.F. Hilton, R.M. Harrison, and J.G. Ayres The effect of sulphur dioxide exposure on indices of heart rate variability in normal and asthmatic adults Eur. Respir. J., April 1, 2001; 17(4): 604 - 608. [Abstract] [Full Text] [PDF]
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 T H Haapaniemi, V Pursiainen, J T Korpelainen, H V Huikuri, K A Sotaniemi, and V V Myllyla Ambulatory ECG and analysis of heart rate variability in Parkinson's disease J. Neurol. Neurosurg. Psychiatry, March 1, 2001; 70(3): 305 - 310. [Abstract] [Full Text] [PDF]
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V. Crasset, S. Mezzetti, M. Antoine, P. Linkowski, J. P. Degaute, and P. van de Borne Effects of Aging and Cardiac Denervation on Heart Rate Variability During Sleep Circulation, January 2, 2001; 103(1): 84 - 88. [Abstract] [Full Text] [PDF]
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C. F. Notarius and J. S. Floras Limitations of the use of spectral analysis of heart rate variability for the estimation of cardiac sympathetic activity in heart failure Europace, January 1, 2001; 3(1): 29 - 38. [Abstract] [PDF]
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 S. Paterniti, M. Zureik, P. Ducimetiere, P.-J. Touboul, J.-M. Feve, and A. Alperovitch Sustained Anxiety and 4-Year Progression of Carotid Atherosclerosis Arterioscler Thromb Vasc Biol, January 1, 2001; 21(1): 136 - 141. [Abstract] [Full Text] [PDF]
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J. W. Hughes and C. M. Stoney Depressed Mood Is Related to High-Frequency Heart Rate Variability During Stressors Psychosom Med, December 1, 2000; 62(6): 796 - 803. [Abstract] [Full Text] [PDF]
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A. Loimaala, H. Huikuri, P. Oja, M. Pasanen, and I. Vuori Controlled 5-mo aerobic training improves heart rate but not heart rate variability or baroreflex sensitivity J Appl Physiol, November 1, 2000; 89(5): 1825 - 1829. [Abstract] [Full Text] [PDF]
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 W. J. Kostis and J. C. Belina Differences in Beat-to-Beat Variability of the QT Interval Between Day and Night Angiology, November 1, 2000; 51(11): 905 - 911. [Abstract] [PDF]
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M. Malik, A. J. Camm, M. J. Janse, D. G. Julian, G. A. Frangin, P. J. Schwartz, and on behalf of the EMIAT Investigators Depressed heart rate variability identifies postinfarction patients who might benefit from prophylactic treatment with amiodarone: A substudy of EMIAT (the European Myocardial Infarct Amiodarone Trial) J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1263 - 1275. [Abstract] [Full Text] [PDF]
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N. Aoyagi, K. Ohashi, S. Tomono, and Y. Yamamoto Temporal contribution of body movement to very long-term heart rate variability in humans Am J Physiol Heart Circ Physiol, April 1, 2000; 278(4): H1035 - H1041. [Abstract] [Full Text] [PDF]
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B Wennerblom, L Lurje, H Tygesen, R Vahisalo, and A Hjalmarson Patients with uncomplicated coronary artery disease have reduced heart rate variability mainly affecting vagal tone Heart, March 1, 2000; 83(3): 290 - 294. [Abstract] [Full Text]
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K. S. Leong, P. Mann, M. Wallymahmed, I. A. MacFarlane, and J. P. H. Wilding Abnormal Heart Rate Variability in Adults with Growth Hormone Deficiency J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 628 - 633. [Abstract] [Full Text]
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