Prognostic significance of long-period heart rate rhythms in chronic heart failure.

BACKGROUND Abnormalities in autonomic control are a feature of neuroendocrine activation in HF and are responsible for dysregulation of biological rhythms. The purpose was to investigate the presence and the prognostic significance of long-period heart rate (HR) rhythms in heart failure (HF) patients. METHODS AND RESULTS In the study, 92 HF patients were enrolled (age 53 ± 14 years and left ventricular ejection fraction [LVEF] 37 ± 10%). A rhythmometric analysis was used to assess the HR rhythms in 7-days (7D) Holter recordings. Rhythms properties were quantified by mesor and amplitude, in beats/min and by acrophase, in hours. Cardiac death or HF decompensation were registered. All patients had 24-h rhythm, 61 patients (77%) had 8-h rhythm, and 66 patients (83%) had 7D rhythm. Twelve patients (15%) experienced events. Among rhythm parameters only 7D median amplitude was different between patients with or without events: 1.1 beats/min [0.5-1.5] vs. 2.0 beats/min [0.0-3.9], P=0.049 respectively. After multivariate adjustment, LVEF (per 1%, hazard ratio 0.92, 95% confidence interval (CI) 0.87 to 0.98, P=0.01), N-terminal portion of pro-natriuretic hormone type B (per 100 pg/ml, hazard ratio 1.036, 95% CI 1.005-1.069, P=0.022), and 7D amplitude of the HR ≤1.71 beats/min (hazard ratio 5.4, 95% CI 1.2-34.4, P=0.047) were independent predictors of events. CONCLUSIONS A 7D HR rhythm is present in most patients with HF, and has prognostic significance.  

[1]  C. Shaw,et al.  Disruption of the circadian clock within the cardiomyocyte influences myocardial contractile function, metabolism, and gene expression. , 2008, American journal of physiology. Heart and circulatory physiology.

[2]  P. Ponikowski,et al.  Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. , 1997, The American journal of cardiology.

[3]  P. Razeghi,et al.  Intrinsic Diurnal Variations in Cardiac Metabolism and Contractile Function , 2001, Circulation research.

[4]  R. Prescott,et al.  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). , 1998, Circulation.

[5]  F. Halberg,et al.  The 17-ketosteroid excretion of a healthy man on weekdays and weekends. , 1965, Experimental medicine and surgery.

[6]  John L Sapp,et al.  Cardiac-resynchronization therapy for mild-to-moderate heart failure. , 2010, The New England journal of medicine.

[7]  E. Haus,et al.  Circaseptan rhythm in sodium and potassium excretion in salt-sensitive and salt-resistant Dahl rats. , 1987, Progress in clinical and biological research.

[8]  S. Goldstein,et al.  The mortality effect of metoprolol CR/XL in patients with heart failure: results of the MERIT-HF Trial. , 1999, Clinical cardiology.

[9]  Phyllis K Stein,et al.  Circadian rhythm in the cardiovascular system: chronocardiology. , 2003, American heart journal.

[10]  Richard B Devereux,et al.  Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardio , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[11]  J. Cohn,et al.  A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. , 2001, The New England journal of medicine.

[12]  Christopher Piorkowski,et al.  :Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up. , 2010, International journal of cardiology.

[13]  J. Daubert,et al.  The effect of cardiac resynchronization on morbidity and mortality in heart failure. , 2005, The New England journal of medicine.

[14]  J. Oss,et al.  PROPHYLACTIC IMPLANTATION OF A DEFIBRILLATOR IN PATIENTS WITH MYOCARDIAL INFARCTION AND REDUCED EJECTION FRACTION , 2002 .

[15]  I. Edery,et al.  Circadian rhythms in a nutshell. , 2000, Physiological genomics.

[16]  M. Slaughter,et al.  Increase in circadian variation after continuous-flow ventricular assist device implantation. , 2010, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[17]  M. Sole,et al.  The Role of Clock Genes in Cardiometabolic Disease Diurnal physiology : core principles with application to the pathogenesis , diagnosis , prevention , and treatment of myocardial hypertrophy and failure , 2009 .

[18]  R. Berger,et al.  B-Type Natriuretic Peptide Predicts Sudden Death in Patients With Chronic Heart Failure , 2002, Circulation.

[19]  Fabio Badilini,et al.  The ISHNE Holter Standard Output File Format , 1998 .

[20]  Rebeca Goya-Esteban,et al.  Heart Rate Variability on 7-Day Holter Monitoring Using a Bootstrap Rhythmometric Procedure , 2010, IEEE Transactions on Biomedical Engineering.

[21]  Theodor Landis,et al.  Usefulness of Ambulatory 7-Day ECG Monitoring for the Detection of Atrial Fibrillation and Flutter After Acute Stroke and Transient Ischemic Attack , 2004, Stroke.

[22]  D. Levy,et al.  Predicting survival in heart failure case and control subjects by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics. , 1997, Circulation.

[23]  Arcadio García-Alberola,et al.  Comparison of detection of arrhythmias in patients with chronic heart failure secondary to non-ischemic versus ischemic cardiomyopathy by 1 versus 7-day holter monitoring. , 2010, The American journal of cardiology.

[24]  S. Boveda,et al.  Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. , 2000, European heart journal.

[25]  L. A. Bonet,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2012, Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir.

[26]  Itsuo Kodama,et al.  Prognostic significance of circadian variability of RR and QT intervals and QT dynamicity in patients with chronic heart failure. , 2007, Heart rhythm.