TY - JOUR
T1 - Heart rate variability monitored by the implanted device predicts response to CRT and long-term clinical outcome in patients with advanced heart failure
AU - Landolina, Maurizio
AU - Gasparini, Maurizio
AU - Lunati, Maurizio
AU - Santini, Massimo
AU - Rordorf, Roberto
AU - Vincenti, Antonio
AU - Diotallevi, Paolo
AU - Montenero, Annibale S.
AU - Bonanno, Carlo
AU - De Santo, Tiziana
AU - Valsecchi, Sergio
AU - Padeletti, Luigi
PY - 2008/11
Y1 - 2008/11
N2 - Background: Few data exist on the long-term changes and the prognostic value of heart rate variability (HRV) assessed by implanted devices in heart failure (HF) patients treated with resynchronization therapy (CRT). Aims: To analyze the long-term changes in the standard deviation of 5-minute median atrial-atrial sensed intervals (SDANN), and assess its role in predicting CRT efficacy and major cardiovascular events. Methods and results: We included 509 consecutive patients implanted with CRT devices. At 12-month follow-up, 44 patients had died and 86 patients had at least one HF hospitalisation. A significant increase in SDANN occurred after 4 weeks of CRT (from 69 ± 22 ms to 82 ± 27 ms, p <0.001). A further increase in SDANN was observed 6 months after implantation. Multivariable analysis identified SDANN as the sole predictor of major cardiovascular events (p = 0.03) among several baseline parameters. SDANN ≤ 65 ms at the first week and SDANN ≤ 76 ms after 4 weeks of CRT yielded the best prediction of all-cause mortality and urgent heart transplantation on Kaplan-Meier analysis (log-rank test p = 0.015 and p = 0.011, respectively for week 1 and 4 values). Moreover, relative reduction in LVESV after CRT significantly correlated with SDANN at week 1 (r = - 0.596, p = 0.012), and week 4 (r = - 0.703, p = 0.001). Conclusions: Device-monitored HRV is a useful tool to identify, early after implantation, patients with a low likelihood of long-term benefits from CRT and at high risk for cardiovascular events.
AB - Background: Few data exist on the long-term changes and the prognostic value of heart rate variability (HRV) assessed by implanted devices in heart failure (HF) patients treated with resynchronization therapy (CRT). Aims: To analyze the long-term changes in the standard deviation of 5-minute median atrial-atrial sensed intervals (SDANN), and assess its role in predicting CRT efficacy and major cardiovascular events. Methods and results: We included 509 consecutive patients implanted with CRT devices. At 12-month follow-up, 44 patients had died and 86 patients had at least one HF hospitalisation. A significant increase in SDANN occurred after 4 weeks of CRT (from 69 ± 22 ms to 82 ± 27 ms, p <0.001). A further increase in SDANN was observed 6 months after implantation. Multivariable analysis identified SDANN as the sole predictor of major cardiovascular events (p = 0.03) among several baseline parameters. SDANN ≤ 65 ms at the first week and SDANN ≤ 76 ms after 4 weeks of CRT yielded the best prediction of all-cause mortality and urgent heart transplantation on Kaplan-Meier analysis (log-rank test p = 0.015 and p = 0.011, respectively for week 1 and 4 values). Moreover, relative reduction in LVESV after CRT significantly correlated with SDANN at week 1 (r = - 0.596, p = 0.012), and week 4 (r = - 0.703, p = 0.001). Conclusions: Device-monitored HRV is a useful tool to identify, early after implantation, patients with a low likelihood of long-term benefits from CRT and at high risk for cardiovascular events.
KW - Heart failure
KW - Heart rate variability
KW - Remodelling
KW - Resynchronization therapy
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U2 - 10.1016/j.ejheart.2008.08.011
DO - 10.1016/j.ejheart.2008.08.011
M3 - Article
C2 - 18838333
AN - SCOPUS:54049121332
VL - 10
SP - 1073
EP - 1079
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 11
ER -