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Autonomic Response to Cardiac Dysfunction in Chronic Heart Failure: A Risk Predictor Based on Autonomic Information Flow
Author(s) -
HOYER DIRK,
MAESTRI ROBERTO,
TERESA LA ROVERE MARIA,
DOMENICO PINNA GIAN
Publication year - 2008
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2007.00971.x
Subject(s) - medicine , cardiology , heart failure , ejection fraction , heart rate , sinus rhythm , heart rate variability , proportional hazards model , autonomic nervous system , blood pressure , atrial fibrillation
Background:Chronic heart failure (CHF) is associated with a complex dysfunction of cardiac, cardiovascular, autonomic, and other mechanisms. Autonomic information flow (AIF) characteristics calculated from heart rate patterns were recently found as promising predictors of outcome in several cardiovascular diseases.Aim:To assess the prognostic value of AIF indices in CHF patients.Methods:We analyzed 24‐hour Holter recordings from 200 consecutive CHF patients in sinus rhythm and computed AIF over the shortest possible interval of an interbeat series, namely over one heart beat interval (BDnn), and over longer intervals (12.5–166.7 seconds, PDmVLF), which reflect slower heart rate modulations. End‐point for survival analysis over three years (Cox model) was total cardiac death. A prognostic model was built (backward elimination) considering known clinical and functional risk factors, and the ability of AIF indices to add prognostic information to this model assessed.Results:Out of candidate predictors, New York Heart Association class, left ventricular ejection fraction, peak VO 2, and systolic pressure were selected as the variables with the highest joint predictive value. When entered into this model, both BDnn and PDmVLF added prognostic information (HR (95%CI): 1.76 (1.00–3.09), P = 0.05, 1.73 (1.05–2.85), P = 0.031 respectively). High risk was associated with reduced fast AIF and increased slower AIF.Conclusion:In CHF patients, AIF indices provide prognostic information independent of known risk factors.