Different spectral components of 24 h heart rate variability are related to different modes of death in chronic heart failure.
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.
Guzzetti
Stefano
S
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
La Rovere
Maria Teresa
MT
Pinna
Gian Domenico
GD
Maestri
Roberto
R
Borroni
Ester
E
Porta
Alberto
A
Mortara
Andrea
A
Malliani
Alberto
A
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