Prospective study of heart rate variability and mortality in chronic heart failure - Results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-Heart)

被引:941
作者
Nolan, J
Batin, PD
Andrews, R
Lindsay, SJ
Brooksby, P
Mullen, H
Baig, W
Flapan, AD
Cowley, A
Prescott, RJ
Neilson, JMM
Fox, KAA
机构
[1] Gen Infirm, Leeds LS1 3EX, W Yorkshire, England
[2] St James Univ Hosp, Leeds, W Yorkshire, England
[3] Queens Med Ctr, Nottingham NG7 2UH, England
[4] Doncaster Royal Infirm, Doncaster DN2 5LT, England
[5] Univ Edinburgh, Edinburgh EH8 9YL, Midlothian, Scotland
关键词
heart rate; heart failure; mortality;
D O I
10.1161/01.CIR.98.15.1510
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Patients with chronic heart failure (CHF) have a continuing high mortality. Autonomic dysfunction may play an important role in the pathophysiology of cardiac death in CHF. UK-HEART examined the value of heart rate variability (HRV) measures as independent predictors of death in CHF. Methods and Results - In a prospective study powered for mortality, we recruited 433 outpatients 62 +/- 9.6 years old with CHF (NYHA functional class I to III; mean ejection fraction, 0.41 +/- 0.17). Time-domain HRV indices and conventional prognostic indicators were related to death by multivariate analysis. During 482 +/- 161 days of follow-up, cardiothoracic ratio, SDNN, left ventricular end-systolic diameter, and serum sodium were significant predictors of all-cause mortality. The risk ratio for a 41.2-ms decrease in SDNN was 1.62 (95% CI, 1.16 to 2.44). The annual mortality rate for the study population in SDNN subgroups was 5.5% for >100 ms, 12.7% for 50 to 100 ms, and 51.4% for <50 ms. SDNN, creatinine, and serum sodium were related to progressive heart failure death. Cardiothoracic ratio, left ventricular end-diastolic diameter, the presence of nonsustained ventricular tachycardia, and serum potassium were related to sudden cardiac death. A reduction in SDNN was the most powerful predictor of the risk of death due to progressive heart failure. Conclusions - CHF is associated with autonomic dysfunction, which can be quantified by measuring HRV. A reduction in SDNN identifies patients at high risk of death and is a better predictor of death due to progressive heart failure than other conventional clinical measurements. High-risk subgroups identified by this measurement are candidates for additional therapy after prescription of an ACE inhibitor.
引用
收藏
页码:1510 / 1516
页数:7
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