Why the study?
Does reduced ultra-low frequency heart rate variability predict progression to aortic valve replacement or sudden cardiac death in asymptomatic or minimally symptomatic patients with chronic severe aortic regurgitation?
Does reduced ultra-low frequency heart rate variability predict progression to aortic valve replacement or sudden cardiac death in asymptomatic or minimally symptomatic patients with chronic severe aortic regurgitation?
Reduced ultra-low frequency heart rate variability (SDANN <145 ms) is a strong, independent predictor of progression to valve surgery or sudden death in asymptomatic patients with chronic severe aortic regurgitation.
May support SDANN-based risk stratification in asymptomatic severe AR; leaves open whether it should guide surgical timing.
We examined the relation of the standard deviation of the 5-minute mean RR intervals over 24 hours (SDANN), a measure of ultra-low frequency heart rate variability (HRV) (<0.0033 Hz), and other measures of HRV to clinical outcome events in 50 asymptomatic or minimally symptomatic patients with chronic severe aortic regurgitation (AR) who underwent ambulatory electrocardiography as part of a prospective study of the natural history of regurgitant valvular diseases. At entry, all patients were in sinus rhythm and had New York Heart Association functional class I or minimal II congestive heart failure, with left ventricular (LV) ejection fraction ≥45% and LV end-diastolic dimension ≥5.5 cm in women and ≥5.9 cm in men. End points were defined as progression to aortic valve replacement (n = 19) or sudden cardiac death (n = 1) during the mean follow-up period of 8.1 ± 3.8 years. With the median SDANN of 145 ms as a partition value, the average annual risk of end-point events in patients with low SDANN was significantly greater than the event rate in patients with high SDANN (11%/year vs 2%/year, p <0.0003). In multivariate analysis, reduced SDANN was associated with end-point events independent of LV function, LV end-systolic dimension, and symptom status (p = 0.001). We conclude that reduced ultra-low frequency HRV measured as SDANN is strongly related to progression to valve surgery in asymptomatic and minimally symptomatic patients with chronic AR. We examined the relation of the standard deviation of the 5-minute mean RR intervals over 24 hours (SDANN) and other measures of heart rate variability to progression to aortic valve replacement or sudden death over a mean 8-year follow-up in 50 asymptomatic or minimally symptomatic patients with chronic severe aortic regurgitation who had normal left ventricular ejection fraction at rest. With the median SDANN of 145 ms as a partition value, the average annual risk of end-point events in patients with low SDANN was significantly greater than the event rate in patients with high SDANN (11%/year vs 2%/year, p <0.0003), and SDANN was associated with end-point events independent of ventricular function, left ventricular end-systolic dimension, and symptom status.
No takes yet. Share an insight, caveat, or question.
Freed et al. (1997) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: