Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients

Junichiro Hayano, Fumihiko Yasuma, Eiichi Watanabe, Robert M. Carney, Phyllis K. Stein, James A. Blumenthal, Petros Arsenos, Konstantinos A. Gatzoulis, Hiroshi Takahashi, Hideki Ishii, Ken Kiyono, Yoshiharu Yamamoto, Yutaka Yoshida, Emi Yuda, Itsuo Kodama

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Abstract

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 (FCV) and amplitude (ACV) 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 endstage 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, FCV did not predict mortality in any cohort. In contrast, decreased ACV 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 ACV was independent of age, gender, diabetes, b-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Conclusion Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients.

Original languageEnglish
Pages (from-to)1392-1400
Number of pages9
JournalEuropace
Volume19
Issue number8
DOIs
Publication statusPublished - 01-08-2017

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Chronic Kidney Failure
Heart Failure
Heart Rate
Myocardial Infarction
Mortality
Electrocardiography
Sleep Apnea Syndromes
Chronic Renal Insufficiency
Stroke Volume
Renal Dialysis
Sleep

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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. In: Europace. 2017 ; Vol. 19, No. 8. pp. 1392-1400.
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title = "Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients",
abstract = "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 (FCV) and amplitude (ACV) 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 endstage 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, FCV did not predict mortality in any cohort. In contrast, decreased ACV 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 ACV was independent of age, gender, diabetes, b-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Conclusion Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients.",
author = "Junichiro Hayano and Fumihiko Yasuma and Eiichi Watanabe and Carney, {Robert M.} and Stein, {Phyllis K.} and Blumenthal, {James A.} and Petros Arsenos and Gatzoulis, {Konstantinos A.} and Hiroshi Takahashi and Hideki Ishii and Ken Kiyono and Yoshiharu Yamamoto and Yutaka Yoshida and Emi Yuda and Itsuo Kodama",
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Hayano, J, Yasuma, F, Watanabe, E, Carney, RM, Stein, PK, Blumenthal, JA, Arsenos, P, Gatzoulis, KA, Takahashi, H, Ishii, H, Kiyono, K, Yamamoto, Y, Yoshida, Y, Yuda, E & Kodama, I 2017, 'Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients', Europace, vol. 19, no. 8, pp. 1392-1400. https://doi.org/10.1093/europace/euw222

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.

In: Europace, Vol. 19, No. 8, 01.08.2017, p. 1392-1400.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Blunted cyclic variation of heart rate predicts mortality risk in post-myocardial infarction, end-stage renal disease, and chronic heart failure patients

AU - Hayano, Junichiro

AU - Yasuma, Fumihiko

AU - Watanabe, Eiichi

AU - Carney, Robert M.

AU - Stein, Phyllis K.

AU - Blumenthal, James A.

AU - Arsenos, Petros

AU - Gatzoulis, Konstantinos A.

AU - Takahashi, Hiroshi

AU - Ishii, Hideki

AU - Kiyono, Ken

AU - Yamamoto, Yoshiharu

AU - Yoshida, Yutaka

AU - Yuda, Emi

AU - Kodama, Itsuo

PY - 2017/8/1

Y1 - 2017/8/1

N2 - 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 (FCV) and amplitude (ACV) 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 endstage 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, FCV did not predict mortality in any cohort. In contrast, decreased ACV 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 ACV was independent of age, gender, diabetes, b-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Conclusion Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients.

AB - 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 (FCV) and amplitude (ACV) 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 endstage 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, FCV did not predict mortality in any cohort. In contrast, decreased ACV 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 ACV was independent of age, gender, diabetes, b-blocker therapy, left ventricular ejection fraction, sleep-time mean R-R interval, and FCV. Conclusion Blunted CVHR detected by decreased ACV in a night-time Holter ECG predicts increased mortality risk in post-MI, ESRD, and CHF patients.

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