Prognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs' Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure).
Although the value of heart rate variability (HRV) for risk stratification after acute myocardial infarction has been demonstrated, the value of low HRV as a predictor of sudden cardiac death in patients with ischemic cardiomyopathy has not been shown convincingly to date. We retrospectively analyzed electrocardiographic data from 179 patients in the Veterans Affairs' Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure to determine if HRV (expressed as the SD of the normal-to-normal RR intervals [SDNN]) would be useful as a predictor of overall mortality and sudden death. Because our goal was to identify high-risk patients, we compared patients in the lowest quartile of HRV with the remaining patients. Among the 127 patients meeting inclusion criteria, SDNN <65.3 ms (the lowest quartile) was the sole independent factor predictive of survival in a multivariate model (p = 0.0001). A Cox proportional-hazards model revealed that each increase of 10 ms in SDNN conferred a 20% decrease in risk of mortality (p = 0.0001). Furthermore, patients with SDNN <65.3 ms had a significantly increased risk of sudden death (p = 0.016). Thus, HRV was the sole independent predictor of overall mortality and was significantly associated with sudden death in this population.
Bilchick
Kenneth C
KC
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Fetics
Barry
B
Djoukeng
Ronnie
R
Fisher
Susan Gross
SG
Fletcher
Ross D
RD
Singh
Steven N
SN
Nevo
Erez
E
Berger
Ronald D
RD
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D002908:Chronic Disease; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016019:Survival Analysis; D014481:United States; D014493:United States Department of Veterans Affairs
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone