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Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction.
J Cardiovasc Electrophysiol. 2005 Jan; 16(1):13-20.JC

Abstract

INTRODUCTION

Decreased heart rate variability (HRV) and abnormal nonlinear HRV shortly after myocardial infarction (MI) are risk factors for mortality. Traditional HRV predicts mortality in patients with a range of times post-MI, but the association of nonlinear HRV and outcome in this population is unknown.

METHODS AND RESULTS

HRV was determined from 740 tapes recorded before antiarrhythmic therapy in Cardiac Arrhythmia Suppression Trial patients with ventricular premature contractions (VPCs) suppressed on the first randomized treatment. Patients were 70 +/- 121 days post-MI. Follow up was 362 +/- 241 days (70 deaths). The association between traditional time and frequency-domain HRV and mortality and nonlinear HRV and mortality were compared for the entire population (ALL), those without coronary artery bypass graft post-MI (no CABG), and those without CABG or diabetes (no CABG, no DIAB) using univariate and multivariate Cox regression analysis. Strength of association was compared by P values and Wald Chi-square values. Nonlinear HRV included short-term fractal scaling exponent, power law slope, and SD12 (Poincare dimension). For ALL and for no CABG, increased daytime SD12 had the strongest association with mortality (P=0.002 ALL and P <0.001 no CABG). For no CABG, no DIAB increased 24-hour SD12 hours had the strongest association (P <0.001) with mortality. Upon multivariate analysis, increased SD12, decreased ln ULF (ultra low frequency), and history of prior MI and history of congestive heart failure each remained in the model.

CONCLUSION

Nonlinear HRV is associated with mortality post-MI. However, as with traditional HRV, this is diluted by CABG surgery post-MI and by diabetes. Results suggest that decreased long-term HRV and increased randomness of heart rate are each independent risk factors for mortality post-MI.

Authors+Show Affiliations

Stein PK
Washington University School of Medicine, St. Louis, Missouri 63108, USA. pstein@im.wustl.edu
Domitrovich PP
No affiliation info available
Huikuri HV
No affiliation info available
Kleiger RE
No affiliation info available
Cast Investigators
No affiliation info available

MeSH

AlgorithmsArrhythmias, CardiacClinical Trials as TopicComorbidityDiagnosis, Computer-AssistedElectrocardiography, AmbulatoryFemaleHeart RateHumansIncidenceMaleMiddle AgedModels, CardiovascularMyocardial InfarctionNonlinear DynamicsPrognosisReproducibility of ResultsRisk AssessmentRisk FactorsSensitivity and SpecificitySurvival AnalysisUnited States

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15673380

Citation

Stein, Phyllis K., et al. "Traditional and Nonlinear Heart Rate Variability Are Each Independently Associated With Mortality After Myocardial Infarction." Journal of Cardiovascular Electrophysiology, vol. 16, no. 1, 2005, pp. 13-20.
Stein PK, Domitrovich PP, Huikuri HV, et al. Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction. J Cardiovasc Electrophysiol. 2005;16(1):13-20.
Stein, P. K., Domitrovich, P. P., Huikuri, H. V., & Kleiger, R. E. (2005). Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction. Journal of Cardiovascular Electrophysiology, 16(1), 13-20.
Stein PK, et al. Traditional and Nonlinear Heart Rate Variability Are Each Independently Associated With Mortality After Myocardial Infarction. J Cardiovasc Electrophysiol. 2005;16(1):13-20. PubMed PMID: 15673380.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction. AU - Stein,Phyllis K, AU - Domitrovich,Peter P, AU - Huikuri,Heikki V, AU - Kleiger,Robert E, AU - ,, PY - 2005/1/28/pubmed PY - 2005/4/29/medline PY - 2005/1/28/entrez SP - 13 EP - 20 JF - Journal of cardiovascular electrophysiology JO - J Cardiovasc Electrophysiol VL - 16 IS - 1 N2 - INTRODUCTION: Decreased heart rate variability (HRV) and abnormal nonlinear HRV shortly after myocardial infarction (MI) are risk factors for mortality. Traditional HRV predicts mortality in patients with a range of times post-MI, but the association of nonlinear HRV and outcome in this population is unknown. METHODS AND RESULTS: HRV was determined from 740 tapes recorded before antiarrhythmic therapy in Cardiac Arrhythmia Suppression Trial patients with ventricular premature contractions (VPCs) suppressed on the first randomized treatment. Patients were 70 +/- 121 days post-MI. Follow up was 362 +/- 241 days (70 deaths). The association between traditional time and frequency-domain HRV and mortality and nonlinear HRV and mortality were compared for the entire population (ALL), those without coronary artery bypass graft post-MI (no CABG), and those without CABG or diabetes (no CABG, no DIAB) using univariate and multivariate Cox regression analysis. Strength of association was compared by P values and Wald Chi-square values. Nonlinear HRV included short-term fractal scaling exponent, power law slope, and SD12 (Poincare dimension). For ALL and for no CABG, increased daytime SD12 had the strongest association with mortality (P=0.002 ALL and P <0.001 no CABG). For no CABG, no DIAB increased 24-hour SD12 hours had the strongest association (P <0.001) with mortality. Upon multivariate analysis, increased SD12, decreased ln ULF (ultra low frequency), and history of prior MI and history of congestive heart failure each remained in the model. CONCLUSION: Nonlinear HRV is associated with mortality post-MI. However, as with traditional HRV, this is diluted by CABG surgery post-MI and by diabetes. Results suggest that decreased long-term HRV and increased randomness of heart rate are each independent risk factors for mortality post-MI. SN - 1045-3873 UR - https://www.unboundmedicine.com/medline/citation/15673380/Traditional_and_nonlinear_heart_rate_variability_are_each_independently_associated_with_mortality_after_myocardial_infarction_ DB - PRIME DP - Unbound Medicine ER -