title: Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction.
abstract: BACKGROUND
  Autonomic nervous system balance can be significantly deteriorated during heart failure exacerbation. However, it is still unknown whether these changes are only the consequence of heart failure decompensation or can also predict development thereof. Objectives were to verify if simple, non-invasive autonomic parameters, such as baroreflex sensitivity and short-term heart rate variability can provide independent of other well-known clinical parameters information on the risk of heart failure decompensation in patients with left ventricular systolic dysfunction.
  
  
  METHODS
  In 142 stable patients with left ventricular ejection fraction ≤ 40%, baroreflex sensitivity and short-term heart rate variability, as well as other well-known clinical parameters, were analyzed. During 23 ± 9 months of follow-up 19 patients were hospitalized due to the heart failure decompensation (EVENT).
  
  
  RESULTS
  Pre-specified cut-off values of baroreflex sensitivity (≤2.4 ms/mmHg) and low frequency power index of heart rate variability (≤19 ms2) were significantly associated with the EVENTs (hazard ratio 4.43, 95% confidence interval [CI] 1.35-14.54 and 5.41, 95% CI 1.87-15.65 respectively). EVENTs were also associated with other parameters, such as left ventricular ejection fraction, NYHA class, diuretic use, renal function, brain natriuretic peptide and hemoglobin level, left atrial size, left and right ventricular heart failure signs. After adjusting baroreflex sensitivity and low frequency power index for each of the abovementioned parameters, autonomic parameters were still significant predictors of hospitalization due to the heart failure decompensation.
  
  
  CONCLUSIONS
  Simple, noninvasive autonomic indices can be helpful in identifying individuals with increased risk of hospitalization due to the heart failure decompensation among clinically stable patients with left ventricular systolic dysfunction, even when adjusted for other well-known clinical parameters.
authors.affiliation: Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Ludmiła
authors.initials: L
authors.lastname: Daniłowicz-Szymanowicz
authors.affiliation: Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Justyna
authors.initials: J
authors.lastname: Suchecka
authors.affiliation: Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Niemirycz-Makurat
authors.affiliation: Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Rozwadowska
authors.affiliation: Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Raczak
mesh_terms: D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology; D017704:Baroreflex; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D020097:Natriuretic Peptide, Brain