Circulation, Vol 90, 878-883, Copyright © 1994 by American Heart Association
H Tsuji, FJ Venditti Jr, ES Manders, JC Evans, MG Larson, CL Feldman and D Levy
BACKGROUND: The prognostic implications of alterations in heart rate
variability have not been studied in a large community-based population.
METHODS AND RESULTS: The first 2 hours of ambulatory ECG recordings
obtained on original subjects of the Framingham Heart Study attending the
18th biennial examination were reprocessed to assess heart rate
variability. Subjects with transient or persistent nonsinus rhythm,
premature beats > 10% of total beats, < 1 hour of recording time,
processed time < 50% of recorded time, and those taking antiarrhythmic
medications were excluded. The associations between heart rate variability
measures and all-cause mortality during 4 years of follow-up were assessed.
There were 736 eligible subjects with a mean age (+/- SD) of 72 +/- 6
years. The following five frequency domain measures and three time domain
measures were obtained: very-low- frequency power (0.01 to 0.04 Hz),
low-frequency power (0.04 to 0.15 Hz), high-frequency power (0.15 to 0.40
Hz), total power (0.01 to 0.40 Hz), the ratio of low-frequency to
high-frequency power, the standard deviation of total normal RR intervals,
the percentage of differences between adjacent normal RR intervals that are
> 50 milliseconds, and the square root of the mean of the squared
differences between adjacent normal RR intervals. During follow-up, 74
subjects died. In separate proportional hazards regression analyses that
adjusted for relevant risk factors, very-low-frequency power (P <
.0001), low-frequency power (P < .0001), high-frequency power (P =
.0014), total power (P < .0001), and the standard deviation of total
normal RR intervals (P = .0019) were significantly associated with
all-cause mortality. When all eight heart rate variability measures were
assessed in a stepwise analysis that included other risk factors,
low-frequency power entered the model first (P < .0001); thereafter,
none of the other measures of heart rate variability significantly
contributed to the prediction of all-cause mortality. A 1 SD decrement in
low-frequency power (natural log transformed) was associated with 1.70
times greater hazard for all- cause mortality (95% confidence interval of
1.37 to 2.09). CONCLUSIONS: The estimation of heart rate variability by
ambulatory monitoring offers prognostic information beyond that provided by
the evaluation of traditional risk factors.
ARTICLES
Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study
Lahey Clinic Medical Center, Burlington, Mass.
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M. Horsten, M. Ericson, A. Perski, S. P. Wamala, K. Schenck-Gustafsson, and K. Orth-Gomer Psychosocial Factors and Heart Rate Variability in Healthy Women Psychosom Med, January 1, 1999; 61(1): 49 - 57. [Abstract] [Full Text] [PDF]
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R Sinnreich, J D Kark, Y Friedlander, D Sapoznikov, and M H Luria Five minute recordings of heart rate variability for population studies: repeatability and age-sex characteristics Heart, August 1, 1998; 80(2): 156 - 162. [Abstract] [Full Text]
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J. P. Singh, M. G. Larson, H. Tsuji, J. C. Evans, C. J. O'Donnell, and D. Levy Reduced Heart Rate Variability and New-Onset Hypertension : Insights Into Pathogenesis of Hypertension: The Framingham Heart Study Hypertension, August 1, 1998; 32(2): 293 - 297. [Abstract] [Full Text] [PDF]
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 D. E. Ford, L. A. Mead, P. P. Chang, L. Cooper-Patrick, N.-Y. Wang, and M. J. Klag Depression Is a Risk Factor for Coronary Artery Disease in Men: The Precursors Study Arch Intern Med, July 13, 1998; 158(13): 1422 - 1426. [Abstract] [Full Text]
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H. Tsuji, M. G. Larson, F. J. Venditti, E. S. Manders, J. C. Evans, C. L. Feldman, and D. Levy Impact of Reduced Heart Rate Variability on Risk for Cardiac Events: The Framingham Heart Study Circulation, December 1, 1996; 94(11): 2850 - 2855. [Abstract] [Full Text]
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 J. T. Korpelainen, K. A. Sotaniemi, H. V. Huikuri, and V. V. Myllyla Abnormal Heart Rate Variability as a Manifestation of Autonomic Dysfunction in Hemispheric Brain Infarction Stroke, November 1, 1996; 27(11): 2059 - 2063. [Abstract] [Full Text]
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H. V. Huikuri, S. M. Pikkujamsa, K.E. J. Airaksinen, M. J. Ikaheimo, A. O. Rantala, H. Kauma, M. Lilja, and Y. A. Kesaniemi Sex-Related Differences in Autonomic Modulation of Heart Rate in Middle-aged Subjects Circulation, July 15, 1996; 94(2): 122 - 125. [Abstract] [Full Text]
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M. S. Lauer, P. M. Okin, M. G. Larson, J. C. Evans, and D. Levy Impaired Heart Rate Response to Graded Exercise : Prognostic Implications of Chronotropic Incompetence in the Framingham Heart Study Circulation, April 15, 1996; 93(8): 1520 - 1526. [Abstract] [Full Text]
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T. F. o. t. E. S. o. C. t. N. A. S. o. P. Electrophysiology Heart Rate Variability : Standards of Measurement, Physiological Interpretation, and Clinical Use Circulation, March 1, 1996; 93(5): 1043 - 1065. [Full Text]
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