Heart rate variability in left ventricular hypertrophy.

BACKGROUND--Electrocardiographic left ventricular hypertrophy and strain are associated with increased cardiac morbidity and mortality. Impaired cardiac autonomic function, assessed non-invasively by spontaneous heart rate variability on Holter monitoring, is associated with an increased risk of sudden death after myocardial infarction. AIM--To study the effect of left ventricular hypertrophy on heart rate variability. PATIENTS--36 controls and 154 patients with left ventricular hypertrophy (94 with hypertension and 60 with aortic valve disease). SETTING--Tertiary referral centre. METHODS--Heart rate variability was measured on 24 h Holter recordings by non-spectral methods. Left ventricular mass index and fractional shortening were measured by echocardiography. RESULTS--Patients with left ventricular hypertrophy had a higher left ventricular mass index (P < 0.001) and reduced heart rate variability (P < 0.001) compared with those of the controls. A continuous inverse relation was apparent between heart rate variability and left ventricular mass index (r = -0.478, P < 0.001). Heart rate variability was not affected by age, the presence of coronary artery disease in patients with left ventricular hypertrophy, or beta blocker treatment for hypertension. Multivariate analysis showed that left ventricular mass index is the most important determinant of heart rate variability. CONCLUSION--Heart rate variability is significantly reduced in patients with left ventricular hypertrophy secondary to hypertension or aortic valve disease. A continuous inverse relation exists between heart rate variability and left ventricular mass index. Impaired cardiac autonomic function in left ventricular hypertrophy may contribute to the mechanism of sudden death.

[1]  T A Sheldon,et al.  Volume and outcome in coronary artery bypass graft surgery: true association or artefact? , 1995, BMJ.

[2]  T. Treasure.  Risks and results of surgery. , 1995, British heart journal.

[3]  N. Wintfeld,et al.  Report cards on cardiac surgeons. Assessing New York State's approach. , 1995, The New England journal of medicine.

[4]  B. Psaty,et al.  Diuretic therapy for hypertension and the risk of primary cardiac arrest. , 1994, The New England journal of medicine.

[5]  E L Hannan,et al.  Improving the outcomes of coronary artery bypass surgery in New York State. , 1994, JAMA.

[6]  S Capewell,et al.  Decreased cardiac parasympathetic activity in chronic heart failure and its relation to left ventricular function. , 1992, British heart journal.

[7]  P. Macfarlane,et al.  Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy. , 1992, British heart journal.

[8]  W. Stevenson,et al.  Patterns of beat-to-beat heart rate variability in advanced heart failure. , 1992, American heart journal.

[9]  A. Camm,et al.  Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. , 1991, Journal of the American College of Cardiology.

[10]  D. Ewing,et al.  Heart rate variability: An important new risk factor in patients following myocardial infarction , 1991, Clinical cardiology.

[11]  M. Flather,et al.  Heart rate variability in acute myocardial infarction and its association with infarct site and clinical course. , 1991, The American journal of cardiology.

[12]  J M Neilson,et al.  Twenty four hour heart rate variability: effects of posture, sleep, and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients. , 1991, British heart journal.

[13]  P Maison-Blanche,et al.  Heart rate variability in left ventricular hypertrophy and heart failure, and the effects of beta-blockade. A non-spectral analysis of heart rate variability in the frequency domain and in the time domain. , 1991, European heart journal.

[14]  M. Chung,et al.  Stability over time of variables measuring heart rate variability in normal subjects. , 1991, The American journal of cardiology.

[15]  A J Camm,et al.  Prognostic value of reduced heart rate variability after myocardial infarction: clinical evaluation of a new analysis method. , 1991, British heart journal.

[16]  R. Ray,et al.  A simple, preoperative scoring system for predicting mortality and intensive care unit stay in adult patients undergoing heart surgery with cardiopulmonary bypass , 1990 .

[17]  P W Macfarlane,et al.  Methodology of ECG Interpretation in the Glasgow Program , 1990, Methods of Information in Medicine.

[18]  J. Hayano,et al.  Decreased magnitude of heart rate spectral components in coronary artery disease. Its relation to angiographic severity. , 1990, Circulation.

[19]  N. Mores,et al.  Heart rate variability and ventricular ectopic activity in hypertensive patients. , 1989, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[20]  P. Friberg,et al.  Sympathetic and parasympathetic influence on blood pressure and heart rate variability in Wistar—Kyoto and spontaneously hypertensive rats , 1988, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[21]  M. Ikäheimo,et al.  Impaired vagal heart rate control in aortic valve stenosis. , 1988, European heart journal.

[22]  M A Hlatky,et al.  Comparison of predictions based on observational data with the results of randomized controlled clinical trials of coronary artery bypass surgery. , 1988, Journal of the American College of Cardiology.

[23]  J. Fleiss,et al.  Components of heart rate variability measured during healing of acute myocardial infarction. , 1988, The American journal of cardiology.

[24]  H. Dargie,et al.  Ventricular arrhythmias in patients with hypertensive left ventricular hypertrophy. , 1987, The New England journal of medicine.

[25]  S G Kim,et al.  The management of patients with life-threatening ventricular tachyarrhythmias: programmed stimulation or Holter monitoring (either or both)? , 1987, Circulation.

[26]  D H Singer,et al.  Heart rate variability and sudden death secondary to coronary artery disease during ambulatory electrocardiographic monitoring. , 1987, The American journal of cardiology.

[27]  J. Miller,et al.  Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. , 1987, The American journal of cardiology.

[28]  M. N. Levy,et al.  Task Force 2 : Sudden cardiac death Neural-cardiac interactions , 2005 .

[29]  E. Hon,et al.  Heart Rate Variability in Diabetes: Relationship to Age and Duration of the Disease , 1985, Diabetes Care.

[30]  J. Laragh,et al.  Standardization of M-mode echocardiographic left ventricular anatomic measurements. , 1984, Journal of the American College of Cardiology.

[31]  F. Dunn,et al.  Hypertension and sudden death. Increased ventricular ectopic activity in left ventricular hypertrophy. , 1984, The American journal of medicine.

[32]  W J Hrushesky,et al.  The respiratory sinus arrhythmia: a measure of cardiac age. , 1984, Science.

[33]  W. Kannel,et al.  Left Ventricular Hypertrophy in Hypertension: Prognostic and Pathogenetic Implications (The Framingham Study) , 1981 .

[34]  N Reichek,et al.  Echocardiographic Determination of Left Ventricular Mass in Man: Anatomic Validation of the Method , 1977, Circulation.

[35]  B Lown,et al.  Neural activity and ventricular fibrillation. , 1976, The New England journal of medicine.

[36]  H Feigenbaum,et al.  Analysis of Left Ventricular Wall Motion by Reflected Ultrasound: Application to Assessment of Myocardial Function , 1972, Circulation.

[37]  B Lown,et al.  Approaches to Sudden Death from Coronary Heart Disease , 1971, Circulation.

[38]  W. Kannel,et al.  Left ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham study. , 1969, Annals of internal medicine.

[39]  D. DuBois,et al.  A formula to estimate the approximate surface area if height and weight be known , 1989 .