title: Heart Rate Variability and Arrhythmic Burden in Pulmonary Hypertension.
abstract: A growing body of evidence indicates that sudden cardiac death constitutes a major cause of mortality in pulmonary hypertension (PH). As validated method to evaluate cardiac autonomic system dysfunction, alterations in heart rate variability (HRV) are predictive of arrhythmic events, particularly in left ventricular disease. Here, we sought to determine the clinical value of HRV assessment in PH. Sixty-four patients were allocated to different PH-subgroups in this prospectively conducted trial: 25 patients with pulmonary arterial hypertension (PAH), 11 patients with chronic thromboembolic PH (CTEPH), and 28 patients with COPD-induced PH. All patients underwent 24-h Holter electrocardiogram for HRV assessment by time- and frequency-domain analysis. Arrhythmic burden was evaluated by manual analysis and complementary automatic measurement of premature atrial and ventricular contractions. The results were compared to 31 healthy controls. The PAH patients offered a significantly higher mean heart rate (78.6 ± 10.4 bpm vs. 70.1 ± 10.3 bpm, p = 0.04), a higher burden of premature ventricular contractions (p < 0.01), and decreases in HRV (SDNN: p < 0.01; SDANN: p < 0.01; very low frequency: p < 0.01; low frequency/high frequency ratio: p < 0.01; total power: p = 0.02). In CTEPH patients, only the amount of premature ventricular contractions differed from controls (p < 0.01), whereas in COPD both premature atrial contraction count and frequency-domain-based HRV manifested significant differences. In conclusion, PAH appears to be primarily affected by HRV alterations and ventricular arrhythmic burden, indicating a high risk for malignant arrhythmic events.
authors.affiliation: Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, 25 Sigmund-Freud-Straße, Bonn, 53105, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Witte
authors.affiliation: Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, 25 Sigmund-Freud-Straße, Bonn, 53105, Germany.
authors.forename: J U
authors.initials: JU
authors.lastname: Meyer Zur Heide Genannt Meyer-Arend
authors.affiliation: Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, 25 Sigmund-Freud-Straße, Bonn, 53105, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Andrié
authors.affiliation: Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, 25 Sigmund-Freud-Straße, Bonn, 53105, Germany.
authors.forename: J W
authors.initials: JW
authors.lastname: Schrickel
authors.affiliation: Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, 25 Sigmund-Freud-Straße, Bonn, 53105, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hammerstingl
authors.affiliation: Department of Cardiology, Beta Clinic, 15 Joseph-Schumpeter-Allee, Bonn, 53227, Germany.
authors.forename: J O
authors.initials: JO
authors.lastname: Schwab
authors.affiliation: Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, 25 Sigmund-Freud-Straße, Bonn, 53105, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, 25 Sigmund-Freud-Straße, Bonn, 53105, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Skowasch
authors.affiliation: Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, 25 Sigmund-Freud-Straße, Bonn, 53105, Germany. carmen.pizarro@ukb.uni-bonn.de.
authors.forename: C
authors.initials: C
authors.lastname: Pizarro
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology*; D001341:Autonomic Nervous System / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000503:physiopathology*
keywords: Atrial fibrillation; Echocardiography; Frequency-domain analysis; Right heart catheterization; Sudden cardiac death; Systolic pulmonary arterial pressure; Time-domain analysis