期刊
EUROPACE
卷 19, 期 8, 页码 1392-1400出版社
OXFORD UNIV PRESS
DOI: 10.1093/europace/euw222
关键词
Ambulatory ECG; Holter ECG; Heart rate; Sleep apnoea; Mortality; Risk stratification
资金
- Japan Society for the Promotion of Science, Japan [20590832, 23591055]
- Grants-in-Aid for Scientific Research [23591055, 17K09533, 20590832] Funding Source: KAKEN
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 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, 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, beta-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.
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