Document Detail

Fractal analysis and time- and frequency-domain measures of heart rate variability as predictors of mortality in patients with heart failure.
MedLine Citation:
PMID:  11152835     Owner:  NLM     Status:  MEDLINE    
Time-domain measures of heart rate (HR) variability provide prognostic information among patients with congestive heart failure (CHF). The prognostic power of spectral and fractal analytic methods of HR variability has not been studied in the patients with chronic CHF. The aim of this study was to assess whether traditional and fractal analytic methods of HR variability predict mortality among a population of patients with CHF. The standard deviation of RR intervals, HR variability index, frequency-domain indexes, and the short-term fractal scaling exponent of RR intervals were studied from 24-hour Holter recordings in 499 patients with CHF and left ventricular ejection fraction < or =35%. During a mean follow-up of 665 +/- 374 days, 210 deaths (42%) occurred in this population. Conventional and fractal HR variability indexes predicted mortality by univariate analysis. For example, a short-term fractal scaling exponent <0.90 had a risk ratio (RR) of 1.9 (95% confidence interval [CI] 1.4 to 2.5) and the SD of all RR intervals <80 ms had an RR of 1.7 (95% CI 1.2 to 2.1). After adjusting for age, functional class, medication, and left ventricular ejection fraction in the multivariate proportional-hazards analysis, the reduced short-term fractal exponent remained the independent predictor of mortality, RR 1.4 (95% CI 1.0 to 1.9; p <0.05). All HR variability indexes were more significant univariate predictors of mortality in functional class II than in class III or IV. Among patients with moderate heart failure, HR variability measurements provide prognostic information, but all HR variability indexes fail to provide independent prognostic information in patients with the most severe functional impairment.
T H Mäkikallio; H V Huikuri; U Hintze; J Videbaek; R D Mitrani; A Castellanos; R J Myerburg; M Møller;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  87     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2001 Jan 
Date Detail:
Created Date:  2001-02-01     Completed Date:  2001-02-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  178-82     Citation Subset:  AIM; IM    
Division of Cardiology, Oulu University Hospital, Finland.
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MeSH Terms
Electrocardiography, Ambulatory
Heart Failure / mortality*,  physiopathology*
Heart Rate*
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Survival Analysis
Ventricular Dysfunction, Left / mortality,  physiopathology

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