Heart Rate Variability Triangular Index as a Predictor of Cardiovascular Mortality in Patients With Atrial Fibrillation.
Heart Rate Variability Triangular Index as a Predictor of Cardiovascular Mortality in Patients With Atrial Fibrillation.
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DOI：
10.1161/jaha.120.016075
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发表时间：
2020-08-04
影响因子：
5.4
通讯作者：
Swiss‐AF Study Investigators
中科院分区：
文献类型：
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作者：
Hämmerle P;Eick C;Blum S;Schlageter V;Bauer A;Rizas KD;Eken C;Coslovsky M;Aeschbacher S;Krisai P;Meyre P;Vesin JM;Rodondi N;Moutzouri E;Beer J;Moschovitis G;Kobza R;Di Valentino M;Corino VDA;Laureanti R;Mainardi L;Bonati LH;Sticherling C;Conen D;Osswald S;Kühne M;Zuern CS;Swiss‐AF Study Investigators
心率变异性 (HRV) 受损与窦性心律死亡率增加相关。然而，尚未对心房颤动 (AF) 患者的 HRV 进行系统评估。我们假设 HRV 参数可以预测 AF 患者的心血管死亡。在多中心前瞻性 Swiss-AF（瑞士心房颤动）队列研究中，我们招募了 1922 名窦性心律或 AF 患者。在基线时获得 5 分钟的静息心电图记录。计算HRV的标准参数（HRV三角指数、正常到正常区间的SD、连续正常到正常区间的均方差的平方根和平均心率）。在随访期间，终点委员会裁定了每种死因。在平均 2.6±1.0 年的随访时间内，143 名患者 (7.4%) 死亡； 92 例死亡归因于心血管原因。在包括多个协变量（年龄、性别、体重指数、吸烟状况、糖尿病史、高血压病史、中风/短暂性脑缺血发作史、心肌梗塞病史、抗心律失常药物（包括β受体阻滞剂、口服抗凝药））的Cox回归模型中，HRV指数降低≤中位数（14.29），但与其他HRV参数无关，与心血管死亡风险增加相关（风险比为1.7； 95% CI，1.1-2.6；P=0.01）和全因死亡（风险比，1.42；95% CI，1.02-1.98；P=0.04）。在一组 AF 患者中通过单次 5 分钟心电图记录测量的 HRV 指数是心血管死亡率的独立预测因子。 AF 患者的 HRV 分析可能是进一步风险分层以指导患者管理的宝贵工具。网址：https://www.clinicaltrials.gov；唯一标识符：NCT02105844。
Impaired heart rate variability (HRV) is associated with increased mortality in sinus rhythm. However, HRV has not been systematically assessed in patients with atrial fibrillation (AF). We hypothesized that parameters of HRV may be predictive of cardiovascular death in patients with AF. From the multicenter prospective Swiss‐AF (Swiss Atrial Fibrillation) Cohort Study, we enrolled 1922 patients who were in sinus rhythm or AF. Resting ECG recordings of 5‐minute duration were obtained at baseline. Standard parameters of HRV (HRV triangular index, SD of the normal‐to‐normal intervals, square root of the mean squared differences of successive normal‐to‐normal intervals and mean heart rate) were calculated. During follow‐up, an end point committee adjudicated each cause of death. During a mean follow‐up time of 2.6±1.0 years, 143 (7.4%) patients died; 92 deaths were attributable to cardiovascular reasons. In a Cox regression model including multiple covariates (age, sex, body mass index, smoking status, history of diabetes mellitus, history of hypertension, history of stroke/transient ischemic attack, history of myocardial infarction, antiarrhythmic drugs including β blockers, oral anticoagulation), a decreased HRV index ≤ median (14.29), but not other HRV parameters, was associated with an increase in the risk of cardiovascular death (hazard ratio, 1.7; 95% CI, 1.1–2.6; P=0.01) and all‐cause death (hazard ratio, 1.42; 95% CI, 1.02–1.98; P=0.04). The HRV index measured in a single 5‐minute ECG recording in a cohort of patients with AF is an independent predictor of cardiovascular mortality. HRV analysis in patients with AF might be a valuable tool for further risk stratification to guide patient management. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.