Prognostic value of heart rate variability and ventricular arrhythmias during 13-year follow-up in patients with mild to moderate heart failure
- First Online:
In contrast to patients with moderate to severe chronic heart failure (CHF), data regarding long-term outcome in patients with mild CHF are scarce. We examined the place of Holter monitoring to study the prognostic value of ventricular arrhythmias and heart rate variability (HRV) in patients with mild to moderate CHF during long-term follow-up.
We studied 90 patients with mild to moderate CHF and NYHA class II who had been enrolled in the Dutch Ibopamine Multicenter Trial. At baseline their mean age was 60.5 ± 8.0 years, left ventricular ejection fraction (LVEF) was 0.29 ± 0.09, and 85% were males. At the start of the study, patients were only using diuretics, while digoxin, and particularly ACE inhibitors and β-blockers were initiated later. Univariate and multivariate proportional hazard analyses were performed.
At baseline 80% of patients were in NYHA class II, and 20% were in class III; their mean age was 60 years, mean LVEF was 0.29, and 85% were men. During a follow-up of 13 years, 47 patients (53%) died. Cardiovascular (CV) death occurred in 39 patients, of which 28 were sudden cardiac death (SCD). For both CV death and SCD, LVEF <30% and ventricular premature beats/h (>20) were independent risk markers. Of the HRV parameters, total power (>2,500 ms2) was an important risk marker for CV death, but not for SCD.
The present 13-year follow-up study in 90 patients with mild to moderate CHF showed that ventricular premature beats and HRV may have important value in predicting outcome.
Keywordschronic heart failure prognosis heart rate variability neurohormones
- 2.Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237PubMedCrossRefGoogle Scholar
- 4.Brouwer J, van Veldhuisen DJ, Man in “t Veld AJ, Dunselman PH, Boomsma F, Haaksma J, Lie KI (1995) Heart rate variability in patients with mild to moderate heart failure: effects of neurohormonal modulation by digoxin and ibopamine The Dutch Ibopamine Multicenter Trial (DIMT) Study Group. J Am Coll Cardiol 26:983–990PubMedCrossRefGoogle Scholar
- 5.Brouwer J, van Veldhuisen DJ, Man in ‘t Veld AJ, Haaksma J, Dijk WA, Visser KR, Boomsma F, Dunselman PH (1996) Prognostic value of heart rate variability during long-term follow-up in patients with mild to moderate heart failure The Dutch Ibopamine Multicenter Trial Study Group. J Am Coll Cardiol 28:1183–1189PubMedCrossRefGoogle Scholar
- 6.Buch P, Rasmussen S, Abildstrom SZ, Kober L, Carlsen J, Torp-Pedersen C (2005) The long-term impact of the angiotensin-converting enzyme inhibitor trandolapril on mortality and hospital admissions in patients with left ventricular dysfunction after a myocardial infarction: follow-up to 12 years. Eur Heart J 26:145–152PubMedCrossRefGoogle Scholar
- 12.Goldman S, Johnson G, Cohn JN, Cintron G, Smith R, Francis G (1993) Mechanism of death in heart failure. The vasodilator-heart failure trials. The V-HeFT VA Cooperative Studies Group. Circulation 87:24–31Google Scholar
- 15.Hampton JR, van Veldhuisen DJ, Kleber FX, Cowley AJ, Ardia A, Block P, Cortina A, Cserhalmi L, Follath F, Jensen G, Kayanakis J, Lie KI, Mancia G, Skene AM (1997) Randomised study of effect of ibopamine on survival in patients with advanced severe heart failure. Second prospective randomised study of ibopamine on mortality and efficacy (PRIME II) investigators. Lancet 349:971–977PubMedCrossRefGoogle Scholar
- 16.(1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93:1043–1065Google Scholar
- 17.Hillege HL, Nitsch D, Pfeffer MA, Swedberg K, McMurray JJ, Yusuf S, Granger CB, Michelson EL, Ostergren J, Cornel JH, de Zeeuw D, Pocock S, van Veldhuisen DJ (2006) Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 113:671–678PubMedCrossRefGoogle Scholar
- 18.Kearney MT, Nolan J, Lee AJ, Brooksby PW, Prescott R, Shah AM, Zaman AG, Eckberg DL, Lindsay HS, Batin PD, Andrews R, Fox KA (2003) A prognostic index to predict long-term mortality in patients with mild to moderate chronic heart failure stabilised on angiotensin converting enzyme inhibitors. Eur J Heart Fail 5:489–497PubMedCrossRefGoogle Scholar
- 19.Kjekshus J, Apetrei E, Barrios V, Bohm M, Cleland JG, Cornel JH, Dunselman P, Fonseca C, Goudev A, Grande P, Gullestad L, Hjalmarson A, Hradec J, Janosi A, Kamensky G, Komajda M, Korewicki J, Kuusi T, Mach F, Mareev V, McMurray JJ, Ranjith N, Schaufelberger M, Vanhaecke J, van Veldhuisen DJ, Waagstein F, Wedel H, Wikstrand J (2007) Rosuvastatin in older patients with systolic heart failure. N Engl J Med 357:2248–2261PubMedCrossRefGoogle Scholar
- 22.McMurray JJ, Teerlink JR, Cotter G, Bourge RC, Cleland JG, Jondeau G, Krum H, Metra M, O’Connor CM, Parker JD, Torre-Amione G, van Veldhuisen DJ, Lewsey J, Frey A, Rainisio M, Kobrin I (2007) Effects of tezosentan on symptoms and clinical outcomes in patients with acute heart failure: the VERITAS randomized controlled trials. JAMA 298:2009–2019PubMedCrossRefGoogle Scholar
- 23.Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, Baig W, Flapan AD, Cowley A, Prescott RJ, Neilson JM, Fox KA (1998) 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). Circulation 98:1510–1516PubMedGoogle Scholar
- 27.Strauss M, Gitt AK, Becker T, Kleemann T, Schiele R, Darius H, Junger C, Senges J, Seidl K (2008) Prehospital cardiac arrest: a marker for higher mortality in patients with acute myocardial infarction and moderately reduced left ventricular function: results from the MITRA plus registry. Clin Res Cardiol 97:748–752PubMedCrossRefGoogle Scholar
- 30.van den Broek SA, van Veldhuisen DJ, de Graeff PA, Landsman ML, Hillege H, Lie KI (1992) Comparison between New York Heart Association classification and peak oxygen consumption in the assessment of functional status and prognosis in patients with mild to moderate chronic congestive heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 70:359–363PubMedCrossRefGoogle Scholar
- 31.van den Broek SA, van Veldhuisen DJ, de Graeff PA, Crijns HJ, van Gilst WH, Hillege H, Lie KI (1993) Mode of death in patients with congestive heart failure: comparison between possible candidates for heart transplantation and patients with less advanced disease. J Heart Lung Transplant 12:367–371PubMedGoogle Scholar
- 33.van Veldhuisen DJ, Man in “t Veld AJ, Dunselman PH, Lok DJ, Dohmen HJ, Poortermans JC, Withagen AJ, Pasteuning WH, Brouwer J, Lie KI (1993) Double-blind placebo-controlled study of ibopamine and digoxin in patients with mild to moderate heart failure: results of the Dutch Ibopamine Multicenter Trial (DIMT). J Am Coll Cardiol 22:1564–1573PubMedCrossRefGoogle Scholar
- 35.van Veldhuisen DJ, Crijns HJ, Girbes AR, Tobe TJ, Wiesfeld AC, Lie KI (1991) Electrophysiologic profile of ibopamine in patients with congestive heart failure and ventricular tachycardia and relation to its effects on hemodynamics and plasma catecholamines. Am J Cardiol 68:1194–1202PubMedCrossRefGoogle Scholar