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An association between heart rate variability and incident heart failure in an elderly cohort
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.ORCID iD: 0000-0003-3493-041x
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.ORCID iD: 0000-0003-2335-8542
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.ORCID iD: 0000-0003-2806-3903
2024 (English)In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 47, no 2Article in journal (Refereed) Published
Abstract [en]

  Background

Early identification of individuals at risk of developing heart failure (HF) may improve poor prognosis. A dominant sympathetic activity is common in HF and associated with worse outcomes; however, less is known about the autonomic balance before HF.

Hypothesis

A low frequency/high frequency (L-F/H-F) ratio, index of heart rate variability, and marker of the autonomic balance predict the development of HF and may improve the performance of the HF prediction model when added to traditional cardiovascular (CV) risk factors.

Methods

Individuals in the PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (n = 1016, all aged 70 years) were included. Exclusion criteria were prevalent HF, electrocardiographic QRS duration ≥130 millisecond, major arrhythmias, or conduction blocks at baseline. The association between the L-F/H-F ratio and incident HF was assessed using Cox proportional hazard analysis. The C-statistic evaluated whether adding the L-F/H-F-ratio to traditional CV risk factors improved the discrimination of incident HF.

Results

HF developed in 107/836 study participants during 15 years of follow-up. A nonlinear, inverse association between the L-F/H-F ratio and incident HF was mainly driven by an L-F/H-F ratio of <30. The association curve was flat for higher values (hazard ratio, HR for the total curve = 0.78 [95% confidence interval, CI: 0.69−0.88, p < .001]; HR = 2 for L-F/H-F ratio = 10). The traditional prediction model improved by 3.3% (p < .03) when the L-F/H-F ratio was added.

Conclusions

An L-F/H-F ratio of <30 was related to incident HF and improved HF prediction when added to traditional CV risk factors.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024. Vol. 47, no 2
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:uu:diva-523878DOI: 10.1002/clc.24241ISI: 001177137700001PubMedID: 38402572OAI: oai:DiVA.org:uu-523878DiVA, id: diva2:1840553
Available from: 2024-02-25 Created: 2024-02-25 Last updated: 2024-04-12Bibliographically approved
In thesis
1. Risk factors for incident heart failure and atrial fibrillation in an elderly population: The role of cardiac conduction and heart rate variability
Open this publication in new window or tab >>Risk factors for incident heart failure and atrial fibrillation in an elderly population: The role of cardiac conduction and heart rate variability
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Heart failure (HF) and atrial fibrillation (AF) are epidemic diseases, frequently coexisting, sharing risk factors and conferring poor prognosis. Identification of individuals at high risk of HF and AF may enable early treatment and improve the prognosis. Reliable prediction models for daily clinical practice are lacking. Early modification and treatment of risk factors may reduce the incidence of AF and HF. Because atrial structure and function abnormalities increase the risk of AF, ECG indices reflecting atrial pathology may prove useful in predicting AF and HF.

The main objectives were to evaluate whether:

  • P-wave duration (Pdur) and PR-interval in V1 predicted incident HF and incident AF (Paper I-II)
  • low frequency/high frequency (L-F/H-F) ratio, a marker of autonomic balance, predicted incident HF (Paper IV)
  • combining selected ECG variables or the L-F/H-F ratio with traditional risk factors improved the performance of the traditional HF prediction model (Paper III-IV).

The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) with 15 years of follow-up was used for all four studies. After applying the exclusion criteria, 836 subjects were evaluated for incident HF (Paper I, III-IV) and 877 subjects for incident AF (Paper II). Cox proportional hazard analysis related ECG-derived variables to incident HF and incident AF. Study III used machine learning to determine which ECG variables correlated to incident HF. C-statistic was used to test whether adding selected ECG variables to traditional HF risk factors improved the performance of the HF prediction model.

Short Pdur was significantly associated with incident HF (Paper I) and incident AF (Paper II). Of 134 ECG variables, high R-wave amplitude variation (SD Ramp) had the highest predictive value for HF (Paper III). A decreased L-F/H-F ratio significantly predicted HF (Paper IV). Adding eight selected ECG variables (Paper III) and the L-F/H-F ratio (Paper IV) to the traditional risk factors significantly improved HF predictive performance by 11.7% and 3.3%, respectively.

In conclusion, the ECG may prove useful for predicting incident HF and AF beyond the traditional risk factors. An autonomic imbalance may precede the development of HF.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2024. p. 57
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2007
Keywords
incident heart failure, incident atrial fibrillation, prediction of heart failure, short P-wave duration, heart rate variability.
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-518489 (URN)978-91-513-2002-1 (ISBN)
Public defence
2024-03-19, Enghoffsalen, Ing 50, Akademiska Sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2024-02-13 Created: 2023-12-19 Last updated: 2024-03-18

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Ostrowska, BozenaLind, LarsBlomström-Lundqvist, Carina

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