title: Heart rate turbulence predicts all-cause mortality and sudden death in congestive heart failure patients.
abstract: BACKGROUND
  Abnormal heart rate turbulence (HRT) has been documented as a strong predictor of total mortality and sudden death in postinfarction patients, but data in patients with congestive heart failure (CHF) are limited.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the prognostic significance of HRT for predicting mortality in CHF patients in New York Heart Association (NYHA) class II-III.
  
  
  METHODS
  In 651 CHF patients with sinus rhythm enrolled into the MUSIC (Muerte Subita en Insuficiencia Cardiaca) study, the standard HRT parameters turbulence onset (TO) and slope (TS), as well as HRT categories, were assessed for predicting total mortality and sudden death.
  
  
  RESULTS
  HRT was analyzable in 607 patients, mean age 63 years (434 male), 50% of ischemic etiology. During a median follow up of 44 months, 129 patients died, 52 from sudden death. Abnormal TS and HRT category 2 (HRT2) were independently associated with increased all-cause mortality (HR: 2.10, CI: 1.41 to 3.12, P <.001 and HR: 2.52, CI: 1.56 to 4.05, P <.001; respectively), sudden death (HR: 2.25, CI: 1.13 to 4.46, P = .021 for HRT2), and death due to heart failure progression (HR: 4.11, CI: 1.84 to 9.19, P <.001 for HRT2) after adjustment for clinical covariates in multivariate analysis. The prognostic value of TS for predicting total mortality was similar in various groups dichotomized by age, gender, NYHA class, left ventricular ejection fraction, and CHF etiology. TS was found to be predictive for total mortality only in patients with QRS > 120 ms.
  
  
  CONCLUSIONS
  HRT is a potent risk predictor for both heart failure and arrhythmic death in patients with class II and III CHF.
authors.affiliation: Catalan Institute of Cardiovascular Sciences, Barcelona, Spain; University of Rochester, Rochester, New York 14642, USA. 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: Rafael
authors.initials: R
authors.lastname: Vazquez
authors.forename: Montserrat
authors.initials: M
authors.lastname: Vallverdu
authors.forename: Jose R
authors.initials: JR
authors.lastname: Gonzalez-Juanatey
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdes
authors.forename: Jesus
authors.initials: J
authors.lastname: Almendral
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
authors.forename: Pere
authors.initials: P
authors.lastname: Caminal
authors.forename: Antoni Bayes
authors.initials: AB
authors.lastname: de Luna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology