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(Circulation. 2004;109:e150-e151.)
© 2004 American Heart Association, Inc.

Correspondence

Heart Rate Turbulence: Higher Predictive Value Than Other Risk Stratifiers?

Niels Wessel, PhD

University of Potsdam, Potsdam, Germany, Franz-Volhard-Hospital, Charité, Humboldt-University, Helios-Clinics, Berlin, Germany

Hagen Malberg, PhD

Forschungszentrum Karlsruhe GmbH, (Karlsruhe Research Center), Karlsruhe, Germany

Thomas Walther, PhD

Department of Cardiology, Medical Center Benjamin Franklin, Freie Universität, Berlin, Germany

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We have read the article by Barthel et al¹ describing the first prospective trial to determine the predictive value of heart rate turbulence (HRT) in patients after acute myocardial infarction. In previous studies, the ability of HRT to predict risk was only determined retrospectively.² We would like to critically discuss here the uniqueness of the emerging risk factor, HRT, in comparison with other parameters. Interestingly, Barthel et al¹ found that HRT was the strongest ECG-based risk predictor. This conclusion is surprising for 2 reasons, as follows. First, in an editorial comment³ on the original article by Schmidt et al,² it was noted that the positive predictive value of HRT is only moderately higher than other ECG risk parameters, and it was suggested that some of the tests should be combined. However, Barthel et al¹ considered only the heart rate variability (HRV) index and, as representatives, 3 other time domain parameters, but they did not analyze frequency domain, nonlinear HRV calculations, late potentials, prolonged QT interval, or T-wave alternans. Second, in a recent study,⁴ we investigated the suitability of short-term HRT (30 minutes) versus HRV analyses to characterize the regulatory differences in patients with dilated cardiomyopathy (DCM, n=37) and healthy controls (n=167). Although premature beats were excluded before HRV analysis, the highest correlation of HRT to HRV parameters was 0.94 in controls and 0.87 in DCM patients. The discrimination rate between DCM patients and controls was 86.3% for the complete data set (without HRT parameters). This rate was . . . [Full Text of this Article]

Petra Barthel, MD; Raphael Schneider; Dipl Ing; Axel Bauer, MD; Kurt Ulm, PhD; Claus Schmitt, MD; Albert Schömig, MD; Georg Schmidt, MD

1 Medizinische Klinik, Institut für Medizinische Statistik und Epidemiologie, der Technischen Universität München, München, Germany

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