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Decreased Heart Rate Variability in Children with Acute Decompensated Heart Failure is Associated with Poor Outcomes

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Abstract

Heart rate variability (HRV) is a noninvasive indicator of the health of neurocardiac interactions of the autonomic nervous system. In adults, decreased HRV correlates with increased cardiovascular mortality. However, the relationship between HRV and outcomes in children with acute decompensated heart failure (ADHF) has not been described. Patients < 21 years old hospitalized with ADHF from 2013 to 2019 were included (N = 79). Primary outcome was defined as death, heart transplant, or mechanical circulatory support (MCS). The median standard deviation of the R-to-R interval in 5-min intervals (SDNN) was calculated from telemetry data obtained across the first 24 h of admission. Patients who met the primary outcome had significantly lower median SDNN (13.8 [7.8, 29.1]) compared to those who did not (24.6 [15.3, 84.4]; p = 0.004). A median SDNN of 20 ms resulted in a sensitivity of 68% and specificity of 69%. Median SDNN < 20 ms represented decreased freedom from primary outcome (p = 0.043) and a hazard ratio of 2.2 in multivariate analysis (p = 0.016). Pediatric patients with ADHF who died, underwent heart transplant, or required MCS had significantly decreased HRV at presentation compared to those that did not. This supports HRV as a noninvasive tool to improve prognostication in children in ADHF.

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Abbreviations

ADHF:

Acute decompensated heart failure

AUC:

Area under the curve

BNP:

B-type natriuretic peptide

CICU:

Cardiac intensive care unit

ECG:

Electrocardiogram

HR:

Hazard ratio

HRV:

Heart rate variability

LVEF:

Left ventricular ejection fraction

LVEDD:

Left ventricular end diastolic dimension

MCS:

Mechanical circulatory support

SDNN:

Standard deviation of the time between two normal QRS complexes

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Funding

Dr. Rusin’s work is supported by the National Institutes of Health award numbers 1R01HL142994 and 4R33HD105593.

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Authors and Affiliations

  1. Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA

    Patrick S. Connell, Jack F. Price, Craig G. Rusin, Taylor S. Howard, Joseph A. Spinner, Santiago O. Valdes, Tam Dan N. Pham, Christina Y. Miyake & Jeffrey J. Kim

  2. Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA

    Christina Y. Miyake

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  1. Patrick S. Connell
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Contributions

PSC, JFP, CGR, and JJK contributed to the initial concept of the manuscript. PSC, JFP, CGR, JAS, and JJK developed the experimental method used for data collection and analysis for the manuscript. PSC and CGR developed the code used in the data collection for the paper. All authors contributed to data analysis and interpretation. PSC wrote the main manuscript text and prepared all figures and tables. All authors reviewed the manuscript.

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Correspondence to Patrick S. Connell.

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Connell, P.S., Price, J.F., Rusin, C.G. et al. Decreased Heart Rate Variability in Children with Acute Decompensated Heart Failure is Associated with Poor Outcomes. Pediatr Cardiol 45, 1767–1775 (2024). https://doi.org/10.1007/s00246-023-03279-7

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  • DOI: https://doi.org/10.1007/s00246-023-03279-7

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