HRV Monitoring Could Predict Cardiac Events: Study

Abnormal HRV parameters may be associated with incident CHF in asymptomatic older adults.

Abnormal heart rate variability (HRV) parameters may be associated with incident congestive heart failure (CHF) in older adults who are asymptomatic, according to new study.

Writing in the Journal of the American College of Cardiology: Heart Failure, Vaiibhav N. Patel, MD (photo), and colleagues at Washington University School of Medicine in St. Louis, Missouri, and the University of Pittsburgh Graduate School of Public Health in Pittsburgh, Pennsylvania, said their findings could help predict the onset of the condition years in advance of a cardiac event.

The authors concluded that HRV improved the predictive ability of the Health Aging and Body Composition Heart Failure (Health ABC) score, a tool that has been validated for CHF.

HRV is the physiological variability observed during the intervals between normal, consecutive heartbeats. When HRV is abnormal, it is a marker of autonomic dysfunction, and, while it has not been associated with the development of CHF, it has been linked to multiple adverse cardiovascular outcomes, including myocardial infarction and sudden cardiac death.

In the study, 1401 participants <71 to >79 years of age underwent baseline 24-hour Holter monitoring. During the study period (median, 10.5 years in follow-up), 19% of the participants developed CHF. These patients were more likely to be male, older, and have a higher body mass index, as well as higher baseline heart rates and systolic blood pressures. They were also more likely to have left ventricular hypertrophy and coronary artery disease.

“In this retrospective analysis, we found that increased ventricular ectopy counts and abnormal HRV measures from 24-hour Holter recordings, including decreased DFA1, decreased CV %, increased ln VLF and abnormal heart rate turbulence onset, added to the predictive power of the Health ABC Heart Failure score to identify asymptomatic older adults at increased risk of developing CHF,” the authors wrote.

This study, which the authors said is the first to show an association between HRV measurements and the development of CHF in an older population of community-dwelling residents, suggests that older adults who have cardiac autonomic dysfunction, as evidenced by abnormal HRV, may be predisposed to the development of CHF even if they are otherwise asymptomatic.

The authors also pointed out that even in low-risk adults with N-terminal pro b-type natriuretic peptide (a measurement used to detect, diagnose, and evaluate the severity of heart failure) of ≤190 pg/mL, abnormal HRV parameters added to the clinical risk model. They posited that HRV improved the predictive power of the Health ABC score when those measurements were added to measurements of increased premature ventricular contractions.

“The potential clinical application of these HRV measures raises intriguing questions,” wrote Philip F. Binkley, MD, MPH, in an accompanying editorial. “If indeed they are predictive of the risk for development of heart failure, what is the clinical response? Other than treating underlying disease processes, there are not clear evidence based preventive strategies for those known to be at risk for heart failure.”

The study, published in the April issue of JACC: Heart Failure, was titled “Association of Holter-Derived Heart Rate Variability Parameters with the Development of Congestive Heart Failure in the Cardiovascular Health Study.”

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