Key result
High CSB/VLF ratio is linked to ~4-fold higher 1-year cardiac event risk in CHF.
Why the study?
Does Cheyne-Stokes breathing detected by heart rate variability predict cardiac events in congestive heart failure outpatients?
Cohort (n=86)
No
Does Cheyne-Stokes breathing detected by heart rate variability predict cardiac events in congestive heart failure outpatients?
Relative Risk: 4.2 (95% CI 1.1–17)
p-value: p=0.04
Ambulatory ECG-derived heart rate variability can detect Cheyne-Stokes breathing, which strongly predicts adverse cardiac events in CHF outpatients.
May support ambulatory risk stratification in CHF outpatients; hypothesis-generating and should not yet change practice.
BACKGROUND: Cheyne-Stokes breathing (CSB) is an abnormal cyclical pattern of respiratory fluctuations observed during sleep in congestive heart failure (CHF) of poor prognosis. We examined the clinical usefulness of CSB screening using the heart rate variability (HRV) data from the ambulatory electrocardiogram. METHODS: We monitored ambulatory electrocardiograms and respiration simultaneously in 86 heart disease patients of both sexes, aged 57 +/- 1 years. HRV was analyzed by the maximum entropy method during the sleeping period (11 PM-5 AM). The 43 CHF patients underwent a 1-year follow-up study. RESULTS: In the power spectra of the HRV, peaks were observed within the CSB band (0.005 to 0.03 Hz). Statistically significant differences in HRV were observed between CSB patients and CSB-free patients in very low frequency (VLF) (P = 0.04), VLF/total frequency (TF) (P = 0.02), CSB (P = 0.01), CSB/TF (P = 0.003), and CSB/VLF (P < 0.0001). Cardiac events occurred in 23% of patients, including cardiac death in two, and rehospitalization for aggravated CHF in eight. In a multivariate Cox regression analysis in which age, sex, ejection fraction, NYHA functional class, beta blocker use, and basic heart disease were included, absence of ACE inhibitor use (RR 5.5, 95% CI 1.0-31) and CSB/VLF > or =80% (RR 4.2, 95% CI 1.1-17) remained significant predictors of cardiac events. CONCLUSIONS: HRV can act as an indicator of the presence of CSB in CHF patients, and could therefore be used, under outpatient conditions, to identify a CHF patients with a poor prognosis.
No takes yet. Share an insight, caveat, or question.
Tateishi et al. (2002) conducted a cohort in Congestive heart failure (n=86). Cheyne-Stokes breathing (CSB/VLF ratio ≥80%) vs. CSB/VLF ratio <80% was evaluated on Cardiac events (sudden cardiac death or readmission to hospital due to worsening CHF) (RR 4.2, 95% CI 1.1-17, p=0.04). A CSB/VLF ratio ≥80% was a significant predictor of cardiac events (RR 4.2, 95% CI 1.1-17, p=0.04) in congestive heart failure outpatients over 1 year of follow-up.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: