Prognostic Value of Heart Rate Variability in Time Domain Analysis in Congestive Heart Failure

  • Serge Boveda
  • Michel Galinier
  • Atul Pathak
  • Joe¨lle Fourcade
  • Bruno Dongay
  • Delphine Benchendikh
  • Pierre Massabuau
  • Jean-Marie Fauvel
  • Jean-Michel Senard
  • Jean-Paul Bounhoure


Aims: Analysis of heart rate variability is a noninvasive tool that allows to study autonomic control of the heart. Several studies have shown disturbed heart rate variability in patients with chronic heart failure (CHF). We sought to assess the prognostic value of time domain measures of heart rate variability in CHF.

Methods and Results: We prospectively enrolled 190 patients with CHF in sinus rhythm, mean age 61±12 years, 109 (57.4 %) in NYHA class II and 81 (42.6 %) in class III or IV, mean cardiothoracic ratio 57.6±6.4 % and mean left ventricular ejection fraction 28.2±8.8 %, 85 (45 %) with ischemic and 105 (55 %) with idiopathic dilated cardiomyopathy. Time domain measures of heart rate variability were obtained from 24[emsp4 ]h Holter ECG recordings. During follow-up (22±18 months), 55 patients died. In multivariate analysis, independent predictors for all-cause mortality were: ischemic heart disease, cardiothoracic ratio ≥60 % and standard deviation of all normal RR intervals <67[emsp4 ]ms (RR=2.5, 95 % CI 1.5–4.2).

Conclusions: Depressed heart rate variability has independent prognostic value in patients with CHF.

heart rate variability prognostic value heart failure 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ho KKL, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: The Framingham Study. J Am Coll Cardiol1993;22(suppl):6A-13A.Google Scholar
  2. 2.
    Galinier M, Vialette JC, Fourcade J, Cabrol P, Dongay B, Massabuau P, Boveda S, Doazan JP, Fauvel JM, Bounhoure JP. QT interval dispersion as a predictor of arrhythmic events in congestive heart failure. Importance of aetiology. Eur Heart J1998; 19:1054-1062.Google Scholar
  3. 3.
    Swedberg K, Eneroth P, Kjekshus J, Wilhelmsen L, for the CONSENSUS Trial Study Group. Hormones regulating cardiovasuclar function in patients with severe congestive heart failure and their relation to mortality. Circulation1990;82:1730-1736.Google Scholar
  4. 4.
    Francis GS, Cohn JN, Johnson G, Rector TS, Goldman S, Simon A. Plasma norepinephrine, plasma renin activity, and congestive heart failure. Relations to survival and the effects of therapy in V-HeFT II. The V-HeFT VA Cooperative Studies Group. Circulation1993;87(suppl VI):VI-40-48.Google Scholar
  5. 5.
    Hirsch AT, Dzau VJ, Creager MA. Baroreceptor function in congestive heart failure: Effect on neurohumoral activation and regional vascular resistance. Circulation1987;75(suppl IV):IV-36-48.Google Scholar
  6. 6.
    Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variabilility: Standards of measurement, physiological interpretation and clinical use. Circulation1996;93:1043-1065.Google Scholar
  7. 7.
    Saul JP, Arai Y, Berger RD, Lilly LS, Colucci WS, Cohen RJ. Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. Am J Cardiol1988;61:1292-1299.Google Scholar
  8. 8.
    Casolo G, Balli E, Taddei T, Amuhasi J, Gori C. Decreased spontaneous heart rate variaibility in congestive heart failure. Am J Cardiol1989;64:1162-1167.Google Scholar
  9. 9.
    Binkley PF, Nunziata E, Hass GJ, Nelson SD, Cody RJ. Parasympathetic withdrawal is an integral component of autonomic imbalance in congestive heart failure: Demonstration in human subjects and verification in a paced canine model of ventricular failure. J Am Coll Cardiol1991;18:464-472.Google Scholar
  10. 10.
    Kienzle MG, Ferguson DW, Birkett CL, Myers GA, Berg WJ, Mariano J. Clinical, hemodynamical and sympathetic neural correlates of heart rate variability in congestive heart failure. Am J Cardiol1992; 69:761-767.Google Scholar
  11. 11.
    Szabo BM, Van Veldhuisen DJ, Brouwer J, Haaksma J, Lie KI. Relation between severity of disease and impairment of heart rate variability parameters in patients with chronic congestive heart failure secondary to coronary artery disease. Am J Cardiol1995;76:713-716.Google Scholar
  12. 12.
    Binder T, Freys N, Porenta G, Heinz G, Wutte M, Kreiner G, Gossinger H, Schmidinger H, Pacher R, Weber H. Prognostic value of heart rate variability in patients awaiting cardiac transplantation. Pacing Clin Electrophysiol1992;15:2215-2220.Google Scholar
  13. 13.
    Mortara A, La Rovere MT, Sigorini MG, Pantaleo P, Pinna G, Martinelli L, Ceconi C, Cerutti S, Tavazzi L. Can power spectral analysis of heart rate variability identify a high risk subgroup of congestive heart failure patients with excessive sympathetic activation? A pilot study before and after heart transplantation. Br Heart J1994;71:422-430.Google Scholar
  14. 14.
    Fei L, Keeling PJ, Gill JS, Bashir Y, Statters DJ, Poloniecki J, McKenna WJ, Camm AJ. Heart rate variability and its relation to ventricular arrhythmias in congestive heart failure. Br Heart J1994;71:322-328.Google Scholar
  15. 15.
    Brouwer J, Van Veldhuisen DJ, Man in't Veld AJ, Haaksman J, Dijk WA, Visser KR, Boomsma F, Dunselman PH, Lie KI, for the Dutch Ibopamine Multicenter Trial Study Group. Prognostic value of heart rate variability during long-term follow-up in patients with mild to moderate heart failure. J Am Coll Cardiol1996;28:1183-1189.Google Scholar
  16. 16.
    Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, Baig W, Flapan AD, Cowley A, Prescott RJ, Neilson JMM, Fox KAA. 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). Circulation1998;98:1510-1516.Google Scholar
  17. 17.
    Ponikowski P, Anker SD, Chua TP, Szelemej R, Piepoli M, Adamopoulos S, Webb-Peploe K, Harrington D, Banasiak W, Wrabek K, Coats AJ. Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol1997;79:1645-1650.Google Scholar
  18. 18.
    Fauchier L, Babuty D, Cosnay P, Autret ML, Fauchier JP. Heart rate variability in idiopathic dilated cardiomyopathy: Characteristics and prognostic value. J Am Coll Cardiol1997;30:1009-1014.Google Scholar
  19. 19.
    Gibelin P, Dadoun-Dybal M, Morand P. Variabilité de la fréquence cardiaque dans l'insuffisance cardiaque chronique: Influence de la gravité et de l'étiologie. Arch Mal Coeur1994;87:1207-1211.Google Scholar
  20. 20.
    Nolan J, Flapan AD, Capewell S, MacDonald T, Neilson JMM, Ewing DJ. Decreased cardiac parasympathetic activity in chronic heart failure and its relation to left ventricular function. Br Heart J1992;67:482-486.Google Scholar
  21. 21.
    Tanabe T, Iwamoto T, Fusegawa Y, Yoshioka K, Shiina Y. Alterations of sympathovagal balance in patients with hypertrophic and dilated cardiomyopathies assessed by spectral analysis of RR interval variability. Eur Heart J1995;16:799-807.Google Scholar
  22. 22.
    Szabo BM, Van Veldhuisen DJ, Van der Veer N, Brouwer J, De Graeff PA, Crijus HJ. Prognostic value of heart rate variability in chronic congestive heart failure secondary to idiopathic of ischaemic dilated cardiomyopathy. Am J Cardiol1997;79:978-980.Google Scholar
  23. 23.
    Parati G, Saul JP, Di Rieuzo M, Mancia G. Spectral analysis of blood pressure and heart rate variability in evaluating cardiovascular regulation: A critical appraisal. Hypertension1995;25:1276-1286.Google Scholar
  24. 24.
    Mortara A, Sleight P, Pinna GD, Maestri R, Prpa A, La Rouvere MT, Cobelli F, Tavazzi L. Abnormal awake respiratory patterns are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability. Circulation1997;96:246-252.Google Scholar
  25. 25.
    Bernadi L, Valle F, Coco M, Calciati A, Sleight P. Physical activity influences heart rate variability and very-low-frequency components in Holter electrocardiograms. Cardiovasc Res1996;32:234-237.Google Scholar
  26. 26.
    Pousset F, Copie X, Lechart P, Jaillon P, Boissel JP, Hetzel M, Fillette F, Remme W, Guize L, Le Heuzey JY. Effects of bisoprolol on heart rate variability in heart failure. Am J Cardiol1996;77:612-617.Google Scholar
  27. 27.
    Slatton ML, Irani WN, Hall SA, Marcoux LG, Page RL, Grayburn PA, Eichhorn EJ. Does digoxin provide additional hemodynamic and autonomic benefit at higher doses in patients with mild to moderate heart failure and normal sinus rhythm? J Am Coll Cardiol1997;29:1206-1213.Google Scholar
  28. 28.
    Adamopoulos S, Ponikowski P, Cerquetani E, Piepoli M, Rosano G, Sleight P, Coats A. Circadian pattern of heart rate variability in chronic heart failure patients: Effects of physical training. Eur Heart J1995;16:1380-1386.Google Scholar
  29. 29.
    Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH, for the US Carvedilol Heart Failure Study Group. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med1996;334:1349-1355.Google Scholar
  30. 30.
    Australia/New Zealand Heart Failure Research Collaborative Group. Randomised placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease. Lancet1997;349:375-380.Google Scholar
  31. 31.
    The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med1997;336:525-533.Google Scholar
  32. 32.
    Tuininga YS, Van Veldhuisen DJ, Brouver J, Haaksma J, Crijns HJGM, Man in't Veld AJ, Lie KI. Heart rate variability in left ventricular dysfunction and heart failure: Effects and implications of drug treatment. Br Heart J1994;72:509-513.Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Serge Boveda
    • 1
  • Michel Galinier
    • 1
  • Atul Pathak
    • 1
  • Joe¨lle Fourcade
    • 1
  • Bruno Dongay
    • 1
  • Delphine Benchendikh
    • 1
  • Pierre Massabuau
    • 1
  • Jean-Marie Fauvel
    • 1
  • Jean-Michel Senard
    • 2
  • Jean-Paul Bounhoure
    • 1
  1. 1.Department of CardiologyRangueil University HospitalToulouseFrance
  2. 2.Pharmacology LaboratoryToulouseFrance

Personalised recommendations