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European Heart Journal 2002 23(2):157-161; doi:10.1053/euhj.2001.2972
Copyright © 2002 by the European Society of Cardiology.
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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.


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