Authors:	Zeid, Silav Buch, Gregor Velmeden, David Söhne, Jakob Schulz, Andreas Schuch, Alexander Tröbs, Sven-Oliver Heidorn, Marc William Müller, Felix Strauch, Konstantin Coboeken, Katrin Lackner, Karl J. Gori, Tommaso Münzel, Thomas Prochaska, Jürgen H. Wild, Philipp S.
Title:	Heart rate variability : reference values and role for clinical profile and mortality in individuals with heart failure
Online publication date:	28-Aug-2023
Year of first publication:	2023
Language:	english
Abstract:	Aims To establish reference values and clinically relevant determinants for measures of heart rate variability (HRV) and to assess their relevance for clinical outcome prediction in individuals with heart failure. Methods Data from the MyoVasc study (NCT04064450; N = 3289), a prospective cohort on chronic heart failure with a highly standardized, 5 h examination, and Holter ECG recording were investigated. HRV markers were selected using a systematic literature screen and a data-driven approach. Reference values were determined from a healthy subsample. Clinical determinants of HRV were investigated via multivariable linear regression analyses, while their relationship with mortality was investigated by multivariable Cox regression analyses. Results Holter ECG recordings were available for analysis in 1001 study participants (mean age 64.5 ± 10.5 years; female sex 35.4%). While the most frequently reported HRV markers in literature were from time and frequency domains, the data-driven approach revealed predominantly non-linear HRV measures. Age, sex, dyslipidemia, family history of myocardial infarction or stroke, peripheral artery disease, and heart failure were strongly related to HRV in multivariable models. In a follow-up period of 6.5 years, acceleration capacity [HRperSD 1.53 (95% CI 1.21/1.93), p = 0.0004], deceleration capacity [HRperSD: 0.70 (95% CI 0.55/0.88), p = 0.002], and time lag [HRperSD 1.22 (95% CI 1.03/1.44), p = 0.018] were the strongest predictors of all-cause mortality in individuals with heart failure independently of cardiovascular risk factors, comorbidities, and medication. Conclusion HRV markers are associated with the cardiovascular clinical profile and are strong and independent predictors of survival in heart failure. This underscores clinical relevance and interventional potential for individuals with heart failure. ClinicalTrials.gov identifier NCT04064450.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-9444
Version:	Published version
Publication type:	Zeitschriftenaufsatz
License:	CC BY
Information on rights of use:	https://creativecommons.org/licenses/by/4.0/
Journal:	Clinical research in cardiology Version of Record (VoR)
Publisher:	Springer
Publisher place:	Berlin
Issue date:	2023
ISSN:	1861-0692
Publisher DOI:	10.1007/s00392-023-02248-7
Appears in collections:	DFG-491381577-H