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Heart Rate Turbulence for Prediction of Heart Transplantation and Mortality in Chronic Heart Failure

Authors

  • Beata Sredniawa M.D.,

    1. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Sylwia Cebula M.D.,

    1. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Jacek Kowalczyk M.D.,

    1. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Velislav N. Batchvarov M.D.,

    1. Division of Cardiac and Vascular Sciences, St. George's University of London, London, U.K.
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  • Agata Musialik-Lydka M.D.,

    1. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Anna Sliwinska M.D.,

    1. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Aleksandra Wozniak M.D.,

    1. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Michal Zakliczynski M.D.,

    1. Department of Cardiac Surgery and Transplantology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Marian Zembala M.D.,

    1. Department of Cardiac Surgery and Transplantology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Zbigniew Kalarus M.D.

    1. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland
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  • Conflict of Interest: All authors state that they do not have any conflict of interest to disclose regarding this manuscript.

Address for correspondence: Beata Sredniawa, M.D., Silesian Center for Heart Diseases, Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Szpitalna 2 Street, 41-800 Zabrze. Fax.: +48323733792; E-mail: bms@pro.onet.pl

Abstract

Background: Previous studies have shown conflicting results about the value of heart rate turbulence (HRT) for risk stratification of patients (pts) with chronic heart failure (CHF). We prospectively evaluated the relation between HRT and progression toward end-stage heart failure or all-cause mortality in patients with CHF.

Methods: HRT was assessed from 24-hour Holter recordings in 110 pts with CHF (54 in NYHA class II, 56 in class III–IV; left ventricular ejection fraction (LVEF) 30%± 10%) on optimal pharmacotherapy and quantified as turbulence onset (TO,%), turbulence slope (TS, ms/RR interval), and turbulence timing (beginning of RR sequence for calculation of TS, TT). TO ≥ 0%, TS ≤ 2.5 ms/RR, and TT >10 were considered abnormal. End point was development of end-stage CHF requiring heart transplantation (OHT) or all-cause mortality.

Results: During a follow-up of 5.8 ± 1.3 years, 24 pts died and 10 required OHT. TO, TS, TT, and both (TO and TS) were abnormal in 35%, 50%, 30%, and 25% of all patients, respectively. Patients with at least one relatively preserved HRT parameter (TO, TS, or TT) (n = 98) had 5-year event-free rate of 83% compared to 33% of those in whom all three parameters were abnormal (n = 12). In multivariate Cox regression analysis, the most powerful predictor of end point events was heart rate variability (SDNN < 70 ms, hazard ratio (HR) 9.41, P < 0.001), followed by LVEF ≤ 35% (HR 6.23), TT ≥ 10 (HR 3.14), and TO ≥ 0 (HR 2.54, P < 0.05).

Conclusion: In patients with CHF on optimal pharmacotherapy, HRT can help to predict those at risk for progression toward OHT or death of all causes.

Ann Noninvasive Electrocardiol 2010;15(3):230–237

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