title: Different spectral components of 24 h heart rate variability are related to different modes of death in chronic heart failure.
abstract: OBJECTIVE
  To assess whether analysis of heart rate variability (HRV) from 24 h Holter recordings provides information about the mode of death (pump failure vs. sudden death) in chronic heart failure (CHF).
  
  
  RESULTS
  We analysed 24 h HRV in 330 consecutive CHF patients in sinus rhythm. Indices derived from time domain, spectral domain, and fractal analyses of 24 h automatic HRV were evaluated. Data from clinical assessment, echocardiography, right heart catheterization, exercise test, blood biochemical examination, and arrhythmia pattern were analysed. Patients were followed up for 3 years. Two simple multivariable models, both including 24 h spectral indices, were able to identify patients at higher risk of progressive pump failure and sudden death, respectively. Depressed power of night-time HRV (< or = 509 ms(2)) below 0.04 Hz [very low frequency (VLF)], high pulmonary wedge pressure (PWP > or = 18 mm Hg) and low left ventricular ejection fraction (LVEF < or = 24%) were independently related to death for progressive pump failure, while the reduction of power between 0.04 and 0.15 Hz at night (LF < or = 20 ms(2)) and increased left ventricular end-systolic diameter (LVESD > or = 61 mm) were linked to sudden mortality.
  
  
  CONCLUSIONS
  Automatic spectral analysis of 24 h HRV provides independent risk indices related to mode of death in sinus rhythm CHF patients.
authors.affiliation: Medicina Interna II e Dipartimento Scienze Cliniche Ospedale Luigi Sacco, Dipartimento Scienze Precliniche L.I.T.A. Vialba, Universita' degli Studi di Milano, Italy. stefanog@fisiopat.sacco.unimi.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Guzzetti
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: La Rovere
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Pinna
authors.forename: Roberto
authors.initials: R
authors.lastname: Maestri
authors.forename: Ester
authors.initials: E
authors.lastname: Borroni
authors.forename: Alberto
authors.initials: A
authors.lastname: Porta
authors.forename: Andrea
authors.initials: A
authors.lastname: Mortara
authors.forename: Alberto
authors.initials: A
authors.lastname: Malliani
mesh_terms: D002940:Circadian Rhythm; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006339:Heart Rate; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D013318:Stroke Volume; D016019:Survival Analysis