Skip Navigation

European Heart Journal 2002 23(2):157-161; doi:10.1053/euhj.2001.2972
Copyright © 2002 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (6)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Reyners, A.K.L.
Right arrow Articles by Smit, A.J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Reyners, A.K.L.
Right arrow Articles by Smit, A.J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Heart rate variability as a predictor of mortality in patients with AA and AL amyloidosis

A.K.L. Reynersa,f1, B.P.C. Hazenbergb, W.D. Reitsmaa and A.J. Smita

a Department of Internal Medicine, University Hospital of Groningen, Groningen, The Netherlands
b Department of Rheumatology, University Hospital of Groningen, Groningen, The Netherlands

revised August 20, 2001; accepted August 22, 2001

Abstract

Aims Patients with AA and AL amyloidosis have a limited life-expectancy. The aim of this study was to investigate whether heart rate variability can predict mortality in these patients.

Methods and Results Twenty-two recently diagnosed patients with AA and 23 patients with AL amyloidosis were included. Fifteen patients (5AA, 10AL) died within 1 year. Twenty-four hour Holter recording was performed to quantify the mean of all normal to normal RR-intervals (mean NN) and the standard deviation of all normal to normal RR-intervals (SDNN). The SDNN predicted 1-year mortality in the total group of patients with amyloidosis. The median SDNN was 73ms. In patients with an SDNN ≤73ms, the risk of dying within 1 year was found to have increased 3·5-fold (P=0·0036; 95%CI 1·1–11·0). An SDNN ≤50ms, a predictor of mortality in other patient groups, increased the risk of dying within 1 year 22-fold (P=0·0001; 95%CI 5·4–90·4). In contrast to patients with AA amyloidosis, in the subgroup analysis of patients with AL amyloidosis the SDNN remained a predictive parameter (SDNN ≤50ms: risk ratio 11·5, 95%CI 2·4–56·2, P=0·0025).

Conclusion The SDNN is a strong predictor of short-term mortality in patients with AL amyloidosis.

Key Words: Autonomic nervous system, heart rate variability, amyloidosis

f1 Correspondence: A. K. L. Reyners, University Hospital of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.

References

  1. Dubrey SW, Cha K, Anderson J. The clinical features of immunoglobulin light-chain (AL) amyloidosis with heart involvement. QJM. 1998;91:141–157[Abstract/Free Full Text]
  2. Kyle RA, Gertz MA, Greipp PR. A trial of three regimens for primary amyloidosis: colchicine, alone, melphalan and prednisone, and melphalan, prednisone and colchicine. N Engl J Med. 1997;336:1202–1207[Abstract/Free Full Text]
  3. Sezer O, Eucker J, Jakob C, Possinger K. Diagnosis and treatment of AL amyloidosis. Clin Nephrol. 2000;53:417–423[ISI][Medline]
  4. Simms RW, Prout MN, Cohen AS. The epidemiology of AL and AA amyloidosis. Baillieres Clin Rheumatol. 1994;8:627–634[CrossRef][ISI][Medline]
  5. Joss N, Mclaughlin K, Simpson K, Boulton-Jones JM. Presentation, survival and prognostic markers in AA amyloidosis. QJM. 2000;93:535–542[Abstract/Free Full Text]
  6. Gertz MA, Kyle RA. Secondary systemic amyloidosis: response and survival in 64 patients. Medicine. 1991;70:246–256[Medline]
  7. Berglund K, Thysell H, Keller C. Results, principles and pitfalls in the management of renal AA-amyloidosis; a 10–21 year follow-up of 16 patients with rheumatic disease treated with alkylating cytostatics. J Rheumatol. 1993;20:2051–2057[ISI][Medline]
  8. Wallis MS, Stough DB IV. Extended survival of patients with primary systemic amyloidosis. Cutis. 1992;49:143
  9. Kyle RA, Gertz MA, Greipp PR. Long-term survival (10 years and more) in 30 patients with primary (AL) amyloidosis. Kyle RA, Gertz MA. Amyloid and amyloidosis 1998. New York: Parthenon Publishing Group; 1999. p. 151–153
  10. Cueto-Garcia L, Reeder GS, Kyle RA. Echocardiographic findings in systemic amyloidosis: spectrum of cardiac involvement and relation to survival. J Am Coll Cardiol. 1985;6:737–743[Abstract]
  11. Hamer JP, Janssen S, van Rijswijk MH, Lie KI. Amyloid cardiomyopathy in systemic non-hereditary amyloidosis. Clinical, echocardiographic findings in 30 patients with AA and 24 patients with AL amyloidosis. Eur Heart J. 1992;13:623–627[Abstract/Free Full Text]
  12. Berg AM, Anderson JJ, Chipkin SR. Autonomic neuropathy in AL (primary) amyloidosis and its effect on survival. Amyloid. 1994;1:39–46
  13. Reyners AKL, Hazenberg BPC, Haagsma EB, Tio RA, Reitsma WD, Smit AJ. The assessment of autonomic function in patients with systemic amyloidosis: methodological considerations. Amyloid. 1998;5:193–199[ISI][Medline]
  14. Husby G. Immunoglobulin-related (AL) amyloidosis. Clin Exp Rheumatol. 1983;1:353–358[ISI][Medline]
  15. Circulation. 1996;93:1043–1065[Free Full Text]
  16. La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998;351:478–484[CrossRef][ISI][Medline]
  17. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59:256–262[CrossRef][ISI][Medline]
  18. Lombardi F, Mortara A. Heart rate variability and cardiac failure. Heart. 1998;80:213–214[Free Full Text]
  19. Tsuji H, Venditti FJ, Manders ES. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation. 1994;90:878–883[Abstract/Free Full Text]
  20. Malik M, Camm AJ, Janse MJ, Julian DG, Frangin GA, Schwartz PJ. Depressed heart rate variability identifies postinfarction patients who might benefit from prophylactic treatment with amiodarone: a substudy of EMIAT (The European Myocardial Infarct Amiodarone Trial). J Am Coll Cardiol. 2000;35:1263–1275[Abstract/Free Full Text]
  21. Dekker JM, Crow RS, Folsom AR. Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC study. Circulation. 2000;102:1239–1244[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
J. B. Selvanayagam, P. N. Hawkins, B. Paul, S. G. Myerson, and S. Neubauer
Evaluation and Management of the Cardiac Amyloidosis
J. Am. Coll. Cardiol., November 27, 2007; 50(22): 2101 - 2110.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Pathol.Home page
I Kholova and H W M Niessen
Amyloid in the cardiovascular system: a review
J. Clin. Pathol., February 1, 2005; 58(2): 125 - 133.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (6)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Reyners, A.K.L.
Right arrow Articles by Smit, A.J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Reyners, A.K.L.
Right arrow Articles by Smit, A.J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?