CIRCADIAN PROPERTIES AND IMPAIRED NIGHT-TIME HEART RATE ADAPTATION MAY BE PROGNOSTIC OF THE ARRHYTHMIC RISK IN HEART FAILURE PATIENTS.
Authors: Polychronis Dilaveris, Petros Arsenos, Konstantinos Gatzoulis, George Manis, Theodoros Gialernios, Anna Kefala, Dimitrios Tsiachris, Apostolos-Ilias Vouliotis, Stefanos Archontakis, Christodoulos Stefanadis, Attila Frigy, Endre Csiki, Cristian Podoleanu, Ildiko Kocsis, Emilian Caraca
Purpose: To examine Circadian properties of Heart Rate (HR) in ventricular arrhythmia prediction among Heart Failure (HF) patients (pts).
Methods: We screened 232 HF pts (age:64±13years, male:84%, LVEF: 32±10, NYHA:2.3±0.5, CAD:82%,
DCMP: 18%) under optimum treatment with ECG, SAECG, ECHO and 24 hours HOLTER. After 21 months of follow up the study population was divided to the HIGH risk(54 pts) and the LOW risk(178pts) groups according to three arrhythmia events/surrogates:1.clinical VT/VF 2. ICD’s appropriate activation 3. confirmed Sudden Cardiac Death. All indices were calculated and statistically analyzed for the two groups. Holter’s signals were analyzed for periods: Entire 24 hours:08.00-0.80, Day-time: 06.00-23.00, Night time:23.00-06.00.
Results: A standard model adjusted for LVEF, fQRS, NSVT 1/24hour and VPBs 240/24 hour was used for multiple logistic regression analysis. Three separate calculations were performed with this model including HR24h /HRday /HRnight . HR night proved to be the only independent and important arrhythmia predictor with OR: 1.031 (p=0.035, 95%CI: 1.002-1.060) (Table 22.1.).
Conclusions: In this HF population, increased night-time mean heart rate was observed in the high-risk arrhythmia group. Therefore, the presence of abolished autonomic nervous system’s ability for adaptation of the mean heart rate to lower levels during night-time may be prognostic of the arrhythmic risk.