Increased non-Gaussianity of heart rate variability predicts cardiac mortality after an acute myocardial infarction

Junichiro Hayano, Ken Kiyono, Zbigniew R. Struzik, Yoshiharu Yamamoto, Eiichi Watanabe, Phyllis K. Stein, Lana L. Watkins, James A. Blumenthal, Robert M. Carney

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Non-Gaussianity index (λ) is a new index of heart rate variability (HRV) that characterizes increased probability of the large heart rate deviations from its trend. A previous study has reported that increased λ is an independent mortality predictor among patients with chronic heart failure. The present study examined predictive value of λ in patients after acute myocardial infarction (AMI). Among 670 post-AMI patients, we performed 24-h Holter monitoring to assess λ and other HRV predictors, including SD of normal-to-normal interval, very-low frequency power, scaling exponent α 1 of detrended fluctuation analysis, deceleration capacity, and heart rate turbulence (HRT). At baseline, λ was not correlated substantially with other HRV indices (|r| <0.4 with either indices) and was decreased in patients taking β-blockers (P = 0.04). During a median follow-up period of 25 months, 45 (6.7%) patients died (32 cardiac and 13 non-cardiac) and 39 recurrent non-fatal AMI occurred among survivors. While all of these HRV indices but λ were significant predictors of both cardiac and non-cardiac deaths, increased λ predicted exclusively cardiac death (RR [95% CI], 1.6 [1.3-2.0] per 1 SD increment, P< 0.0001). The predictive power of increased λ was significant even after adjustments for clinical risk factors, such as age, diabetes, left ventricular function, renal function, prior AMI, heart failure, and stroke, Killip class, and treatment ([95% CI], 1.4 [1.1-2.0] per 1 SD increment, P = 0.01). The prognostic power of increased λ for cardiac death was also independent of all other HRV indices and the combination of increased λ and abnormal HRT provided the best predictive model for cardiac death. Neither λ nor other HRV indices was an independent predictor of AMI recurrence. Among post-AMI patients, increased λ is associated exclusively with increased cardiac mortality risk and its predictive power is independent of clinical risk factors and of other HRV predictors.

Original languageEnglish
Article numberArticle 65
JournalFrontiers in Physiology
Volume2 SEP
DOIs
Publication statusPublished - 01-12-2011

Fingerprint

Heart Rate
Myocardial Infarction
Mortality
Heart Failure
Ambulatory Electrocardiography
Deceleration
Left Ventricular Function
Survivors
Stroke
Kidney
Recurrence

All Science Journal Classification (ASJC) codes

  • Physiology
  • Physiology (medical)

Cite this

Hayano, Junichiro ; Kiyono, Ken ; Struzik, Zbigniew R. ; Yamamoto, Yoshiharu ; Watanabe, Eiichi ; Stein, Phyllis K. ; Watkins, Lana L. ; Blumenthal, James A. ; Carney, Robert M. / Increased non-Gaussianity of heart rate variability predicts cardiac mortality after an acute myocardial infarction. In: Frontiers in Physiology. 2011 ; Vol. 2 SEP.
@article{8628347ec47b41418a03d41809ef16ed,
title = "Increased non-Gaussianity of heart rate variability predicts cardiac mortality after an acute myocardial infarction",
abstract = "Non-Gaussianity index (λ) is a new index of heart rate variability (HRV) that characterizes increased probability of the large heart rate deviations from its trend. A previous study has reported that increased λ is an independent mortality predictor among patients with chronic heart failure. The present study examined predictive value of λ in patients after acute myocardial infarction (AMI). Among 670 post-AMI patients, we performed 24-h Holter monitoring to assess λ and other HRV predictors, including SD of normal-to-normal interval, very-low frequency power, scaling exponent α 1 of detrended fluctuation analysis, deceleration capacity, and heart rate turbulence (HRT). At baseline, λ was not correlated substantially with other HRV indices (|r| <0.4 with either indices) and was decreased in patients taking β-blockers (P = 0.04). During a median follow-up period of 25 months, 45 (6.7{\%}) patients died (32 cardiac and 13 non-cardiac) and 39 recurrent non-fatal AMI occurred among survivors. While all of these HRV indices but λ were significant predictors of both cardiac and non-cardiac deaths, increased λ predicted exclusively cardiac death (RR [95{\%} CI], 1.6 [1.3-2.0] per 1 SD increment, P< 0.0001). The predictive power of increased λ was significant even after adjustments for clinical risk factors, such as age, diabetes, left ventricular function, renal function, prior AMI, heart failure, and stroke, Killip class, and treatment ([95{\%} CI], 1.4 [1.1-2.0] per 1 SD increment, P = 0.01). The prognostic power of increased λ for cardiac death was also independent of all other HRV indices and the combination of increased λ and abnormal HRT provided the best predictive model for cardiac death. Neither λ nor other HRV indices was an independent predictor of AMI recurrence. Among post-AMI patients, increased λ is associated exclusively with increased cardiac mortality risk and its predictive power is independent of clinical risk factors and of other HRV predictors.",
author = "Junichiro Hayano and Ken Kiyono and Struzik, {Zbigniew R.} and Yoshiharu Yamamoto and Eiichi Watanabe and Stein, {Phyllis K.} and Watkins, {Lana L.} and Blumenthal, {James A.} and Carney, {Robert M.}",
year = "2011",
month = "12",
day = "1",
doi = "10.3389/fphys.2011.00065",
language = "English",
volume = "2 SEP",
journal = "Frontiers in Physiology",
issn = "1664-042X",
publisher = "Frontiers Research Foundation",

}

Hayano, J, Kiyono, K, Struzik, ZR, Yamamoto, Y, Watanabe, E, Stein, PK, Watkins, LL, Blumenthal, JA & Carney, RM 2011, 'Increased non-Gaussianity of heart rate variability predicts cardiac mortality after an acute myocardial infarction', Frontiers in Physiology, vol. 2 SEP, Article 65. https://doi.org/10.3389/fphys.2011.00065

Increased non-Gaussianity of heart rate variability predicts cardiac mortality after an acute myocardial infarction. / Hayano, Junichiro; Kiyono, Ken; Struzik, Zbigniew R.; Yamamoto, Yoshiharu; Watanabe, Eiichi; Stein, Phyllis K.; Watkins, Lana L.; Blumenthal, James A.; Carney, Robert M.

In: Frontiers in Physiology, Vol. 2 SEP, Article 65, 01.12.2011.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Increased non-Gaussianity of heart rate variability predicts cardiac mortality after an acute myocardial infarction

AU - Hayano, Junichiro

AU - Kiyono, Ken

AU - Struzik, Zbigniew R.

AU - Yamamoto, Yoshiharu

AU - Watanabe, Eiichi

AU - Stein, Phyllis K.

AU - Watkins, Lana L.

AU - Blumenthal, James A.

AU - Carney, Robert M.

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Non-Gaussianity index (λ) is a new index of heart rate variability (HRV) that characterizes increased probability of the large heart rate deviations from its trend. A previous study has reported that increased λ is an independent mortality predictor among patients with chronic heart failure. The present study examined predictive value of λ in patients after acute myocardial infarction (AMI). Among 670 post-AMI patients, we performed 24-h Holter monitoring to assess λ and other HRV predictors, including SD of normal-to-normal interval, very-low frequency power, scaling exponent α 1 of detrended fluctuation analysis, deceleration capacity, and heart rate turbulence (HRT). At baseline, λ was not correlated substantially with other HRV indices (|r| <0.4 with either indices) and was decreased in patients taking β-blockers (P = 0.04). During a median follow-up period of 25 months, 45 (6.7%) patients died (32 cardiac and 13 non-cardiac) and 39 recurrent non-fatal AMI occurred among survivors. While all of these HRV indices but λ were significant predictors of both cardiac and non-cardiac deaths, increased λ predicted exclusively cardiac death (RR [95% CI], 1.6 [1.3-2.0] per 1 SD increment, P< 0.0001). The predictive power of increased λ was significant even after adjustments for clinical risk factors, such as age, diabetes, left ventricular function, renal function, prior AMI, heart failure, and stroke, Killip class, and treatment ([95% CI], 1.4 [1.1-2.0] per 1 SD increment, P = 0.01). The prognostic power of increased λ for cardiac death was also independent of all other HRV indices and the combination of increased λ and abnormal HRT provided the best predictive model for cardiac death. Neither λ nor other HRV indices was an independent predictor of AMI recurrence. Among post-AMI patients, increased λ is associated exclusively with increased cardiac mortality risk and its predictive power is independent of clinical risk factors and of other HRV predictors.

AB - Non-Gaussianity index (λ) is a new index of heart rate variability (HRV) that characterizes increased probability of the large heart rate deviations from its trend. A previous study has reported that increased λ is an independent mortality predictor among patients with chronic heart failure. The present study examined predictive value of λ in patients after acute myocardial infarction (AMI). Among 670 post-AMI patients, we performed 24-h Holter monitoring to assess λ and other HRV predictors, including SD of normal-to-normal interval, very-low frequency power, scaling exponent α 1 of detrended fluctuation analysis, deceleration capacity, and heart rate turbulence (HRT). At baseline, λ was not correlated substantially with other HRV indices (|r| <0.4 with either indices) and was decreased in patients taking β-blockers (P = 0.04). During a median follow-up period of 25 months, 45 (6.7%) patients died (32 cardiac and 13 non-cardiac) and 39 recurrent non-fatal AMI occurred among survivors. While all of these HRV indices but λ were significant predictors of both cardiac and non-cardiac deaths, increased λ predicted exclusively cardiac death (RR [95% CI], 1.6 [1.3-2.0] per 1 SD increment, P< 0.0001). The predictive power of increased λ was significant even after adjustments for clinical risk factors, such as age, diabetes, left ventricular function, renal function, prior AMI, heart failure, and stroke, Killip class, and treatment ([95% CI], 1.4 [1.1-2.0] per 1 SD increment, P = 0.01). The prognostic power of increased λ for cardiac death was also independent of all other HRV indices and the combination of increased λ and abnormal HRT provided the best predictive model for cardiac death. Neither λ nor other HRV indices was an independent predictor of AMI recurrence. Among post-AMI patients, increased λ is associated exclusively with increased cardiac mortality risk and its predictive power is independent of clinical risk factors and of other HRV predictors.

UR - http://www.scopus.com/inward/record.url?scp=84866167039&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866167039&partnerID=8YFLogxK

U2 - 10.3389/fphys.2011.00065

DO - 10.3389/fphys.2011.00065

M3 - Article

C2 - 21994495

AN - SCOPUS:84866167039

VL - 2 SEP

JO - Frontiers in Physiology

JF - Frontiers in Physiology

SN - 1664-042X

M1 - Article 65

ER -