Regular paperPrognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs’ Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure)☆
Section snippets
CHF-STAT study design:
The design of the CHF-STAT study is described elsewhere.1, 2 Briefly, patients with a documented history of congestive heart failure (EF <40%), whether ischemic or nonischemic in origin, and at least 10 ventricular premature beats/hour, unaccompanied by symptoms, were eligible for the study. Exclusion criteria included myocardial infarction within the 3 months before enrollment, symptomatic ventricular arrhythmia, a history of aborted sudden cardiac arrest or sustained ventricular tachycardia,
Demographics:
Of the 179 patients in our sample, 52 were excluded from our analysis. Reasons for exclusion were excessive ectopy (n = 21), atrial fibrillation (n = 14), pacing (n = 12), and problems with the quality of the Holter recording (n = 5).
The study analysis included 127 patients (mean age 64.7 years). Table 1lists the demographics for these patients. Seventy-two were assigned to amiodarone and 55 to placebo. Most patients were in NYHA class II and III with a mean LVEF of 26%; slightly more than 3/4
Discussion
The key finding in this study was that SDNN, a measure of HRV, was the sole predictor of overall mortality and was significantly associated with sudden death in this chronic heart failure cohort. Bigger et al3, 4 established the prognostic value of SDNN measured shortly after acute myocardial infarction. Our findings extend these results to the chronic heart failure period. Our study population represents a cross section of patients with heart failure, predominantly NYHA class II and III.
Acknowledgements
We thank Steven Schulman, MD, and David Kass, MD, for their many suggestions in the writing of this manuscript.
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This work was supported by Grants P50 HL52307 and R44 HL61903 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. The CHF-STAT study was supported by the Cooperative Studies Program of the U.S. Department of Veterans Affairs Research and Development Service, Sanofi Winthrop Recherche, Paris, France; and Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania.