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From The General Infirmary and St James's University Hospital,
Leeds (J.N., P.D.B., S.J.L.); Queens Medical Centre, Nottingham (R.A., P.B.,
A.C.); The Royal Infirmary, Doncaster (M.M., W.B.); and the University of
Edinburgh (A.D.F., R.J.P., J.M.M.N., K.A.A.F.).
Correspondence to Dr J. Nolan, Cardiothoracic Centre, North Staffordshire Hospital, Staffordshire ST4 6QG, UK.
Background—Patients with chronic
heart failure (CHF) have a continuing high mortality. Autonomic
dysfunction may play an important role in the pathophysiology of
cardiac death in CHF. UK-HEART examined the value of heart rate
variability (HRV) measures as independent predictors of death in
CHF.
Methods and Results—In a prospective study powered for mortality,
we recruited 433 outpatients 62±9.6 years old with CHF (NYHA
functional class I to III; mean ejection fraction, 0.41±0.17).
Time-domain HRV indices and conventional prognostic indicators were
related to death by multivariate analysis.
During 482±161 days of follow-up, cardiothoracic ratio, SDNN, left
ventricular end-systolic diameter, and serum sodium
were significant predictors of all-cause mortality. The risk ratio for
a 41.2-ms decrease in SDNN was 1.62 (95% CI, 1.16 to 2.44). The annual
mortality rate for the study population in SDNN subgroups was 5.5% for
>100 ms, 12.7% for 50 to 100 ms, and 51.4% for <50 ms. SDNN,
creatinine, and serum sodium were related to progressive
heart failure death. Cardiothoracic ratio, left ventricular
end-diastolic diameter, the presence of nonsustained
ventricular tachycardia, and serum potassium
were related to sudden cardiac death. A reduction in SDNN was the most
powerful predictor of the risk of death due to progressive heart
failure.
Conclusions—CHF is associated with autonomic dysfunction, which
can be quantified by measuring HRV. A reduction in SDNN identifies
patients at high risk of death and is a better predictor of death due
to progressive heart failure than other conventional clinical
measurements. High-risk subgroups identified by this measurement are
candidates for additional therapy after prescription of an ACE
inhibitor.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Prospective Study of Heart Rate Variability and Mortality in Chronic Heart Failure
Results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-Heart)
Key Words: heart rate • heart failure • mortality
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W. G. Stevenson and L. M. Epstein Predicting Sudden Death Risk for Heart Failure Patients in the Implantable Cardioverter-Defibrillator Age Circulation, February 4, 2003; 107(4): 514 - 516. [Full Text] [PDF]
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M. T. La Rovere, G. D. Pinna, R. Maestri, A. Mortara, S. Capomolla, O. Febo, R. Ferrari, M. Franchini, M. Gnemmi, C. Opasich, et al. Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients Circulation, February 4, 2003; 107(4): 565 - 570. [Abstract] [Full Text] [PDF]
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T. Yamada, T. Shimonagata, M. Fukunami, K. Kumagai, H. Ogita, A. Hirata, M. Asai, N. Makino, H. Kioka, H. Kusuoka, et al. Comparison of the prognostic value of cardiac iodine-123 metaiodobenzylguanidine imaging and heart rate variability in patients with chronic heart failure: A prospective study J. Am. Coll. Cardiol., January 15, 2003; 41(2): 231 - 238. [Abstract] [Full Text] [PDF]
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J. Muntwyler, G. Abetel, C. Gruner, and F. Follath One-year mortality among unselected outpatients with heart failure Eur. Heart J., December 1, 2002; 23(23): 1861 - 1866. [Abstract] [Full Text] [PDF]
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C A J Farquharson and A D Struthers Increasing plasma potassium with amiloride shortens the QT interval and reduces ventricular extrasystoles but does not change endothelial function or heart rate variability in chronic heart failure Heart, December 1, 2002; 88(5): 475 - 480. [Abstract] [Full Text] [PDF]
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M. T. Kearney, K. A. A. Fox, A. J. Lee, R. J. Prescott, A. M. Shah, P. D. Batin, W. Baig, S. Lindsay, T. S. Callahan, W. E. Shell, et al. Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1801 - 1808. [Abstract] [Full Text] [PDF]
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G. Malfatto, G. Branzi, B. Riva, L. Sala, G. Leonetti, and M. Facchini Recovery of cardiac autonomic responsiveness with low-intensity physical training in patients with chronic heart failure Eur J Heart Fail, March 1, 2002; 4(2): 159 - 166. [Abstract] [Full Text] [PDF]
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S. C. Malpas Neural influences on cardiovascular variability: possibilities and pitfalls Am J Physiol Heart Circ Physiol, January 1, 2002; 282(1): H6 - H20. [Abstract] [Full Text] [PDF]
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S. Chowdhary, S. L. Nuttall, J. H. Coote, and J. N. Townend L-Arginine Augments Cardiac Vagal Control in Healthy Human Subjects Hypertension, January 1, 2002; 39(1): 51 - 56. [Abstract] [Full Text] [PDF]
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L. Bernardi, P. Sleight, G. Bandinelli, S. Cencetti, L. Fattorini, J. Wdowczyc-Szulc, and A. Lagi Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study BMJ, December 22, 2001; 323(7327): 1446 - 1449. [Abstract] [Full Text] [PDF]
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A. T. Yan, T. D. Bradley, and P. P. Liu The Role of Continuous Positive Airway Pressure in the Treatment of Congestive Heart Failure Chest, November 1, 2001; 120(5): 1675 - 1685. [Abstract] [Full Text] [PDF]
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S. R. Magari, R. Hauser, J. Schwartz, P. L. Williams, T. J. Smith, and D. C. Christiani Association of Heart Rate Variability With Occupational and Environmental Exposure to Particulate Air Pollution Circulation, August 28, 2001; 104(9): 986 - 991. [Abstract] [Full Text] [PDF]
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N P GALL, M T KEARNEY, A ZAMAN, S O'NUNAIN, K A A FOX, A FLAPAN, and J NOLAN Implementation of the NICE guidelines for the primary prevention of mortality from ventricular tachyarrhythmias: implications for UK electrophysiology centres; activity modelling from the UK-HEART study Heart, August 1, 2001; 86(2): 219a - 220. [Full Text]
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K.-M. Yee, S. D. Pringle, and A. D. Struthers Circadian variation in the effects of aldosterone blockade on heart rate variability and QT dispersion in congestive heart failure J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1800 - 1807. [Abstract] [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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X. Jouven, M. Zureik, M. Desnos, C. Guerot, and P. Ducimetiere Resting heart rate as a predictive risk factor for sudden death in middle-aged men Cardiovasc Res, May 1, 2001; 50(2): 373 - 378. [Abstract] [Full Text] [PDF]
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G. Malfatto, G. Branzi, S. Gritti, L. Sala, R. Bragato, G. B. Perego, G. Leonetti, and M. Facchini Different baseline sympathovagal balance and cardiac autonomic responsiveness in ischemic and non-ischemic congestive heart failure Eur J Heart Fail, March 1, 2001; 3(2): 197 - 202. [Abstract] [Full Text] [PDF]
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M. Kornitzer Predictive value of electrocardiographic markers for autonomic nervous system dysfunction in healthy populations: more studies needed Eur. Heart J., January 2, 2001; 22(2): 109 - 112. [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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