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European Heart Journal Advance Access originally published online on December 9, 2004
European Heart Journal 2005 26(4):357-362; doi:10.1093/eurheartj/ehi067
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© The European Society of Cardiology 2004. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

Different spectral components of 24 h heart rate variability are related to different modes of death in chronic heart failure

Stefano Guzzetti1,*, Maria Teresa La Rovere2, Gian Domenico Pinna2, Roberto Maestri2, Ester Borroni1, Alberto Porta1, Andrea Mortara3 and Alberto Malliani1

1Medicina Interna II e Dipartimento Scienze Cliniche Ospedale ‘Luigi Sacco’, Dipartimento Scienze Precliniche L.I.T.A. Vialba, Universita' degli Studi di Milano, Italy
2Divisione di Cardiologia e Bioingegneria, Fondazione ‘S. Maugeri’ IRCCS, Istituto Scientifico di Montescano, Montescano (Pavia), Italy
3Divisione di Cardiologia e Unità Scompenso Cardiaco, Policlinico di Monza, Monza, Italy

Received 5 January 2004; revised 5 October 2004; accepted 28 October 2004; online publish-ahead-of-print 9 December 2004.

* Corresponding author. Tel: +39 2 357 99753; fax: +39 2 356 4630. E-mail address: stefanog{at}fisiopat.sacco.unimi.it

Aims To assess whether analysis of heart rate variability (HRV) from 24 h Holter recordings provides information about the mode of death (pump failure vs. sudden death) in chronic heart failure (CHF).

Methods and results We analysed 24 h HRV in 330 consecutive CHF patients in sinus rhythm. Indices derived from time domain, spectral domain, and fractal analyses of 24 h automatic HRV were evaluated. Data from clinical assessment, echocardiography, right heart catheterization, exercise test, blood biochemical examination, and arrhythmia pattern were analysed. Patients were followed up for 3 years. Two simple multivariable models, both including 24 h spectral indices, were able to identify patients at higher risk of progressive pump failure and sudden death, respectively. Depressed power of night-time HRV (≤509  ms2) below 0.04 Hz [very low frequency (VLF)], high pulmonary wedge pressure (PWP≥18 mm Hg) and low left ventricular ejection fraction (LVEF≤24%) were independently related to death for progressive pump failure, while the reduction of power between 0.04 and 0.15 Hz at night (LF≤20 ms2) and increased left ventricular end-systolic diameter (LVESD≥61 mm) were linked to sudden mortality.

Conclusion Automatic spectral analysis of 24 h HRV provides independent risk indices related to mode of death in sinus rhythm CHF patients.

Key Words: Heart failure • Sudden death • Progressive pump failure • Heart rate variability • Autonomic nervous system


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