Non-Gaussian heart rate as an independent predictor of mortality in patients with chronic heart failure

Ken Kiyono, Junichiro Hayano, Eiichi Watanabe, Zbigniew R. Struzik, Yoshiharu Yamamoto

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: Morbidity and mortality due to chronic heart failure remain unacceptably high despite effective drug therapies, and the search for a better risk predictor is ongoing. Statistics derived from beat-to-beat fluctuations in heart rate or heart rate variability (HRV) have been used for this purpose, but the current predictability level is low or moderate at best. Objective: The purpose of this study was to evaluate whether a recently proposed non-Gaussian index of HRV is a significant and independent mortality predictor in patients with congestive heart failure (CHF). Methods: Twenty-four-hour Holter ECGs from 108 CHF patients were evaluated. Thirty-nine (36.1%) of the patients died during the follow-up period of 33 ± 17 months. Cox proportional hazards regression analysis was performed to determine factors related to all-cause mortality. The factors evaluated derived from clinical information, including plasma brain natriuretic peptide, conventional time- and frequency-domain and fractal HRV measures, and a recently proposed non-Gaussian index λ of HRV. Results: The short-term (<40 beats) non-Gaussian index λ40 (hazard ratio per increment of unit standard deviation 1.64, 95% confidence interval [1.23, 2.18], P <.001) and the long-term (<1,000 beats) index λ1000 (hazard ratio 1.42, 95% confidence interval [1.07, 2.18], P <.02), together with brain natriuretic peptide (hazard ratio 2.26, 95% confidence interval [1.45, 3.53], P <.001), are significant univariate risk predictors of mortality. In a multivariate model, λ40 (1.49, [1.13, 1.96], P <.005) and brain natriuretic peptide (2.39, [1.53, 3.75], P <.001) are independent predictors of the survival statistics of patients. None of the conventional HRV measures have predicted the mortality of patients in a significant and independent manner. Conclusion: The results of this study indicate the usefulness of the short-term non-Gaussian index of HRV for risk prediction in patients with CHF.

Original languageEnglish
Pages (from-to)261-268
Number of pages8
JournalHeart Rhythm
Volume5
Issue number2
DOIs
Publication statusPublished - 01-02-2008

Fingerprint

Heart Failure
Heart Rate
Mortality
Brain Natriuretic Peptide
Confidence Intervals
Fractals
Electrocardiography
Regression Analysis
Morbidity
Drug Therapy
Survival

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kiyono, Ken ; Hayano, Junichiro ; Watanabe, Eiichi ; Struzik, Zbigniew R. ; Yamamoto, Yoshiharu. / Non-Gaussian heart rate as an independent predictor of mortality in patients with chronic heart failure. In: Heart Rhythm. 2008 ; Vol. 5, No. 2. pp. 261-268.
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abstract = "Background: Morbidity and mortality due to chronic heart failure remain unacceptably high despite effective drug therapies, and the search for a better risk predictor is ongoing. Statistics derived from beat-to-beat fluctuations in heart rate or heart rate variability (HRV) have been used for this purpose, but the current predictability level is low or moderate at best. Objective: The purpose of this study was to evaluate whether a recently proposed non-Gaussian index of HRV is a significant and independent mortality predictor in patients with congestive heart failure (CHF). Methods: Twenty-four-hour Holter ECGs from 108 CHF patients were evaluated. Thirty-nine (36.1{\%}) of the patients died during the follow-up period of 33 ± 17 months. Cox proportional hazards regression analysis was performed to determine factors related to all-cause mortality. The factors evaluated derived from clinical information, including plasma brain natriuretic peptide, conventional time- and frequency-domain and fractal HRV measures, and a recently proposed non-Gaussian index λ of HRV. Results: The short-term (<40 beats) non-Gaussian index λ40 (hazard ratio per increment of unit standard deviation 1.64, 95{\%} confidence interval [1.23, 2.18], P <.001) and the long-term (<1,000 beats) index λ1000 (hazard ratio 1.42, 95{\%} confidence interval [1.07, 2.18], P <.02), together with brain natriuretic peptide (hazard ratio 2.26, 95{\%} confidence interval [1.45, 3.53], P <.001), are significant univariate risk predictors of mortality. In a multivariate model, λ40 (1.49, [1.13, 1.96], P <.005) and brain natriuretic peptide (2.39, [1.53, 3.75], P <.001) are independent predictors of the survival statistics of patients. None of the conventional HRV measures have predicted the mortality of patients in a significant and independent manner. Conclusion: The results of this study indicate the usefulness of the short-term non-Gaussian index of HRV for risk prediction in patients with CHF.",
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Non-Gaussian heart rate as an independent predictor of mortality in patients with chronic heart failure. / Kiyono, Ken; Hayano, Junichiro; Watanabe, Eiichi; Struzik, Zbigniew R.; Yamamoto, Yoshiharu.

In: Heart Rhythm, Vol. 5, No. 2, 01.02.2008, p. 261-268.

Research output: Contribution to journalArticle

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T1 - Non-Gaussian heart rate as an independent predictor of mortality in patients with chronic heart failure

AU - Kiyono, Ken

AU - Hayano, Junichiro

AU - Watanabe, Eiichi

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AU - Yamamoto, Yoshiharu

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N2 - Background: Morbidity and mortality due to chronic heart failure remain unacceptably high despite effective drug therapies, and the search for a better risk predictor is ongoing. Statistics derived from beat-to-beat fluctuations in heart rate or heart rate variability (HRV) have been used for this purpose, but the current predictability level is low or moderate at best. Objective: The purpose of this study was to evaluate whether a recently proposed non-Gaussian index of HRV is a significant and independent mortality predictor in patients with congestive heart failure (CHF). Methods: Twenty-four-hour Holter ECGs from 108 CHF patients were evaluated. Thirty-nine (36.1%) of the patients died during the follow-up period of 33 ± 17 months. Cox proportional hazards regression analysis was performed to determine factors related to all-cause mortality. The factors evaluated derived from clinical information, including plasma brain natriuretic peptide, conventional time- and frequency-domain and fractal HRV measures, and a recently proposed non-Gaussian index λ of HRV. Results: The short-term (<40 beats) non-Gaussian index λ40 (hazard ratio per increment of unit standard deviation 1.64, 95% confidence interval [1.23, 2.18], P <.001) and the long-term (<1,000 beats) index λ1000 (hazard ratio 1.42, 95% confidence interval [1.07, 2.18], P <.02), together with brain natriuretic peptide (hazard ratio 2.26, 95% confidence interval [1.45, 3.53], P <.001), are significant univariate risk predictors of mortality. In a multivariate model, λ40 (1.49, [1.13, 1.96], P <.005) and brain natriuretic peptide (2.39, [1.53, 3.75], P <.001) are independent predictors of the survival statistics of patients. None of the conventional HRV measures have predicted the mortality of patients in a significant and independent manner. Conclusion: The results of this study indicate the usefulness of the short-term non-Gaussian index of HRV for risk prediction in patients with CHF.

AB - Background: Morbidity and mortality due to chronic heart failure remain unacceptably high despite effective drug therapies, and the search for a better risk predictor is ongoing. Statistics derived from beat-to-beat fluctuations in heart rate or heart rate variability (HRV) have been used for this purpose, but the current predictability level is low or moderate at best. Objective: The purpose of this study was to evaluate whether a recently proposed non-Gaussian index of HRV is a significant and independent mortality predictor in patients with congestive heart failure (CHF). Methods: Twenty-four-hour Holter ECGs from 108 CHF patients were evaluated. Thirty-nine (36.1%) of the patients died during the follow-up period of 33 ± 17 months. Cox proportional hazards regression analysis was performed to determine factors related to all-cause mortality. The factors evaluated derived from clinical information, including plasma brain natriuretic peptide, conventional time- and frequency-domain and fractal HRV measures, and a recently proposed non-Gaussian index λ of HRV. Results: The short-term (<40 beats) non-Gaussian index λ40 (hazard ratio per increment of unit standard deviation 1.64, 95% confidence interval [1.23, 2.18], P <.001) and the long-term (<1,000 beats) index λ1000 (hazard ratio 1.42, 95% confidence interval [1.07, 2.18], P <.02), together with brain natriuretic peptide (hazard ratio 2.26, 95% confidence interval [1.45, 3.53], P <.001), are significant univariate risk predictors of mortality. In a multivariate model, λ40 (1.49, [1.13, 1.96], P <.005) and brain natriuretic peptide (2.39, [1.53, 3.75], P <.001) are independent predictors of the survival statistics of patients. None of the conventional HRV measures have predicted the mortality of patients in a significant and independent manner. Conclusion: The results of this study indicate the usefulness of the short-term non-Gaussian index of HRV for risk prediction in patients with CHF.

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