Prognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs’ Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure)

doi:10.1016/S0002-9149(02)02380-9

The American Journal of Cardiology

Volume 90, Issue 1, 1 July 2002, Pages 24-28

https://doi.org/10.1016/S0002-9149(02)02380-9 Get rights and content

Abstract

Although the value of heart rate variability (HRV) for risk stratification after acute myocardial infarction has been demonstrated, the value of low HRV as a predictor of sudden cardiac death in patients with ischemic cardiomyopathy has not been shown convincingly to date. We retrospectively analyzed electrocardiographic data from 179 patients in the Veterans Affairs’ Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure to determine if HRV (expressed as the SD of the normal-to-normal RR intervals [SDNN]) would be useful as a predictor of overall mortality and sudden death. Because our goal was to identify high-risk patients, we compared patients in the lowest quartile of HRV with the remaining patients. Among the 127 patients meeting inclusion criteria, SDNN <65.3 ms (the lowest quartile) was the sole independent factor predictive of survival in a multivariate model (p = 0.0001). A Cox proportional-hazards model revealed that each increase of 10 ms in SDNN conferred a 20% decrease in risk of mortality (p = 0.0001). Furthermore, patients with SDNN <65.3 ms had a significantly increased risk of sudden death (p = 0.016). Thus, HRV was the sole independent predictor of overall mortality and was significantly associated with sudden death in this population.

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.

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Regular paperPrognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs’ Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure)☆

Abstract

Section snippets

CHF-STAT study design:

Demographics:

Discussion

Acknowledgements

Control Clin Trials

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Regular paper
Prognostic value of heart rate variability in chronic congestive heart failure (Veterans Affairs’ Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure)☆