title: Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction.
abstract: BACKGROUND
  Decreased heart rate variability (HRV) and abnormal nonlinear HRV shortly after myocardial infarction (MI) are risk factors for mortality. Traditional HRV predicts mortality in patients with a range of times post-MI, but the association of nonlinear HRV and outcome in this population is unknown.
  
  
  RESULTS
  HRV was determined from 740 tapes recorded before antiarrhythmic therapy in Cardiac Arrhythmia Suppression Trial patients with ventricular premature contractions (VPCs) suppressed on the first randomized treatment. Patients were 70 +/- 121 days post-MI. Follow up was 362 +/- 241 days (70 deaths). The association between traditional time and frequency-domain HRV and mortality and nonlinear HRV and mortality were compared for the entire population (ALL), those without coronary artery bypass graft post-MI (no CABG), and those without CABG or diabetes (no CABG, no DIAB) using univariate and multivariate Cox regression analysis. Strength of association was compared by P values and Wald Chi-square values. Nonlinear HRV included short-term fractal scaling exponent, power law slope, and SD12 (Poincare dimension). For ALL and for no CABG, increased daytime SD12 had the strongest association with mortality (P=0.002 ALL and P <0.001 no CABG). For no CABG, no DIAB increased 24-hour SD12 hours had the strongest association (P <0.001) with mortality. Upon multivariate analysis, increased SD12, decreased ln ULF (ultra low frequency), and history of prior MI and history of congestive heart failure each remained in the model.
  
  
  CONCLUSIONS
  Nonlinear HRV is associated with mortality post-MI. However, as with traditional HRV, this is diluted by CABG surgery post-MI and by diabetes. Results suggest that decreased long-term HRV and increased randomness of heart rate are each independent risk factors for mortality post-MI.
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri 63108, USA. pstein@im.wustl.edu
authors.forename: Phyllis K
authors.initials: PK
authors.lastname: Stein
authors.forename: Peter P
authors.initials: PP
authors.lastname: Domitrovich
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kleiger
mesh_terms: D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006339:Heart Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality*; D017711:Nonlinear Dynamics; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology