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Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients
AIMS: Cyclic variation of heart rate (CVHR) associated with sleep-disordered breathing is thought to reflect cardiac autonomic responses to apnoeic/hypoxic stress. We examined whether blunted CVHR observed in ambulatory ECG could predict the mortality risk. METHODS AND RESULTS: CVHR in night-time Ho...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834062/ https://www.ncbi.nlm.nih.gov/pubmed/27789562 http://dx.doi.org/10.1093/europace/euw222 |
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author | Hayano, Junichiro Yasuma, Fumihiko Watanabe, Eiichi Carney, Robert M. Stein, Phyllis K. Blumenthal, James A. Arsenos, Petros Gatzoulis, Konstantinos A. Takahashi, Hiroshi Ishii, Hideki Kiyono, Ken Yamamoto, Yoshiharu Yoshida, Yutaka Yuda, Emi Kodama, Itsuo |
author_facet | Hayano, Junichiro Yasuma, Fumihiko Watanabe, Eiichi Carney, Robert M. Stein, Phyllis K. Blumenthal, James A. Arsenos, Petros Gatzoulis, Konstantinos A. Takahashi, Hiroshi Ishii, Hideki Kiyono, Ken Yamamoto, Yoshiharu Yoshida, Yutaka Yuda, Emi Kodama, Itsuo |
author_sort | Hayano, Junichiro |
collection | PubMed |
description | AIMS: Cyclic variation of heart rate (CVHR) associated with sleep-disordered breathing is thought to reflect cardiac autonomic responses to apnoeic/hypoxic stress. We examined whether blunted CVHR observed in ambulatory ECG could predict the mortality risk. METHODS AND RESULTS: CVHR in night-time Holter ECG was detected by an automated algorithm, and the prognostic relationships of the frequency (F(CV)) and amplitude (A(CV)) of CVHR were examined in 717 patients after myocardial infarction (post-MI 1, 6% mortality, median follow-up 25 months). The predictive power was prospectively validated in three independent cohorts: a second group of 220 post-MI patients (post-MI 2, 25.5% mortality, follow-up 45 months); 299 patients with end-stage renal disease on chronic haemodialysis (ESRD, 28.1% mortality, follow-up 85 months); and 100 patients with chronic heart failure (CHF, 35% mortality, follow-up 38 months). Although CVHR was observed in ≥96% of the patients in all cohorts, F(CV) did not predict mortality in any cohort. In contrast, decreased A(CV) was a powerful predictor of mortality in the post-MI 1 cohort (hazard ratio [95% CI] per 1 ln [ms] decrement, 2.9 [2.2–3.7], P < 0.001). This prognostic relationship was validated in the post-MI 2 (1.8 [1.4–2.2], P < 0.001), ESRD (1.5 [1.3–1.8], P < 0.001), and CHF (1.4 [1.1–1.8], P = 0.02) cohorts. The prognostic value of A(CV) was independent of age, gender, diabetes, β-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and F(CV). CONCLUSION: Blunted CVHR detected by decreased A(CV) in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients. |
format | Online Article Text |
id | pubmed-5834062 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-58340622018-03-07 Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients Hayano, Junichiro Yasuma, Fumihiko Watanabe, Eiichi Carney, Robert M. Stein, Phyllis K. Blumenthal, James A. Arsenos, Petros Gatzoulis, Konstantinos A. Takahashi, Hiroshi Ishii, Hideki Kiyono, Ken Yamamoto, Yoshiharu Yoshida, Yutaka Yuda, Emi Kodama, Itsuo Europace Clinical Research AIMS: Cyclic variation of heart rate (CVHR) associated with sleep-disordered breathing is thought to reflect cardiac autonomic responses to apnoeic/hypoxic stress. We examined whether blunted CVHR observed in ambulatory ECG could predict the mortality risk. METHODS AND RESULTS: CVHR in night-time Holter ECG was detected by an automated algorithm, and the prognostic relationships of the frequency (F(CV)) and amplitude (A(CV)) of CVHR were examined in 717 patients after myocardial infarction (post-MI 1, 6% mortality, median follow-up 25 months). The predictive power was prospectively validated in three independent cohorts: a second group of 220 post-MI patients (post-MI 2, 25.5% mortality, follow-up 45 months); 299 patients with end-stage renal disease on chronic haemodialysis (ESRD, 28.1% mortality, follow-up 85 months); and 100 patients with chronic heart failure (CHF, 35% mortality, follow-up 38 months). Although CVHR was observed in ≥96% of the patients in all cohorts, F(CV) did not predict mortality in any cohort. In contrast, decreased A(CV) was a powerful predictor of mortality in the post-MI 1 cohort (hazard ratio [95% CI] per 1 ln [ms] decrement, 2.9 [2.2–3.7], P < 0.001). This prognostic relationship was validated in the post-MI 2 (1.8 [1.4–2.2], P < 0.001), ESRD (1.5 [1.3–1.8], P < 0.001), and CHF (1.4 [1.1–1.8], P = 0.02) cohorts. The prognostic value of A(CV) was independent of age, gender, diabetes, β-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and F(CV). CONCLUSION: Blunted CVHR detected by decreased A(CV) in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients. Oxford University Press 2017-08 2016-10-27 /pmc/articles/PMC5834062/ /pubmed/27789562 http://dx.doi.org/10.1093/europace/euw222 Text en © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Clinical Research Hayano, Junichiro Yasuma, Fumihiko Watanabe, Eiichi Carney, Robert M. Stein, Phyllis K. Blumenthal, James A. Arsenos, Petros Gatzoulis, Konstantinos A. Takahashi, Hiroshi Ishii, Hideki Kiyono, Ken Yamamoto, Yoshiharu Yoshida, Yutaka Yuda, Emi Kodama, Itsuo Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients |
title | Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients |
title_full | Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients |
title_fullStr | Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients |
title_full_unstemmed | Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients |
title_short | Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients |
title_sort | blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5834062/ https://www.ncbi.nlm.nih.gov/pubmed/27789562 http://dx.doi.org/10.1093/europace/euw222 |
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