title: Prognostic value of Holter monitoring in congestive heart failure.
abstract: Congestive heart failure (CHF) is an increasingly widespread, costly and deadly disease, frequently named as epidemics of the 21 century. Despite advancement in modern treatment, mortality rate in CHF patients remains high. Therefore, risk stratification in patients with CHF remains one of the major challenges of contemporary cardiology. Electrocardiographic parameters based on ambulatory Holter monitoring have been documented to be independent risk predictors of total mortality and progression of heart failure. Recent years brought an increased interest in evaluation of dynamic Holter-derived ECG markers reflecting changes in heart rate and ventricular repolarization behavior. It is widely accepted that structural changes reflecting myocardial substrate are better identified by means of imaging techniques, Holter monitoring on the other hand provides complementary information on myocardial vulnerability and autonomic nervous system. Therefore, combining the electrocardiographic stratification with assessment of myocardial substrate may provide the complex insight into interplay between factors contributing to death. The present article reviews the literature data on the prognostic role of various Holter-based ECG parameters, with special emphasis to dynamic ECG risk markers--heart rate variability, heart rate turbulence, repolarization dynamics and variability--in predicting mortality, as well as different modes of death in patients with CHF.
authors.affiliation: Department of Electrocardiology, Sterling Memorial University Hospital, Łódź, Poland. iwona.cygankiewicz@heart.rochester.edu
authors.forename: Iwona
authors.initials: I
authors.lastname: Cygankiewicz
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
authors.forename: Antoni Bayes
authors.initials: AB
authors.lastname: de Luna
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D001341:Autonomic Nervous System / Q000503:physiopathology; D016757:Death, Sudden, Cardiac; D018450:Disease Progression; D004562:Electrocardiography / Q000379:methods; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006339:Heart Rate; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000628:therapy