Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure

Galinier, Michel; Pathak, Atul; Fourcade, J; Androdias, C; Curnier, Daniel; Varnous, S.; Boveda, Serge; Massabuau, P; Fauvel, M.; Senard, Jean‐Michel; Bounhoure, Jean Paul

doi:10.1053/euhj.1999.1875

Cited by 253 publications

(185 citation statements)

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“…Decreased M 2 R expression has been previously reported in left ventricular hypertrophy or chronic heart failure, two situations associated with an increased risk of cardiovascular mortality. 25,26 Similar changes have been described in a canine model of dietary-induced obesity 17 and, following analysis of their heart rates, it has been suggested that these changes could also occur in obese patients. 27 In vivo studies assessing cardiac muscarinic receptivity are limited by confounding factors such as interactions between various circulating agents (leptin, free fatty acids) and insulin.…”

Section: Discussionmentioning

confidence: 72%

Insulin downregulates M2-muscarinic receptors in adult rat atrial cardiomyocytes: a link between obesity and cardiovascular complications

et al. 2004

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OBJECTIVE:To determine whether decreased cardiac parasympathetic activity observed in obesity is due to insulin-induced alterations in cardiac M 2 -muscarinic receptors and/or adenylyl cyclase activity. DESIGN AND METHODS: After incubation with increasing concentrations of insulin, adult rat atrial cardiomyocytes were assayed for M 2 -muscarinic receptor binding density and affinity, and for M 2 R mRNA expression using RT-PCR analysis. Forskolinstimulated adenylyl cyclase activity and its inhibition by carbachol were also assayed, as was endothelial nitric oxide synthase mRNA expression. The effects of insulin on M 2 -muscarinic receptor density and mRNA expression levels were analyzed using the insulin signaling inhibitors rapamycin, wortmanin and PD 098059. RESULTS: Insulin induces a concentration-and time-dependent decrease in expression of the M 2 R mRNA, and in [ 3 H]Nmethylscopolamine binding by the receptor. These effects on the M 2 R mRNA levels and on [ 3 H]N-methylscopolamine binding were prevented by PD 98059, but not by wortmanin or rapamycin. Basal and forskolin-induced cAMP production did not differ, but the inhibition of forskolin-simulated enzyme activity by carbachol was blunted by insulin. No change in the mRNA levels for endothelial nitric oxide synthase was observed. CONCLUSION: In rat atrial cardiomyocytes, insulin markedly alters both the M 2 -muscarinc receptor density, and its mRNA expression through transcriptional regulation and adenylyl cyclase activity. These data suggest that the obesity-associated decrease in cardiac parasympathetic tone may be related to hyperinsulinemia, which could directly contribute to cardiovascular morbidity in obese patients.

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Section: Discussionmentioning

confidence: 72%

Insulin downregulates M2-muscarinic receptors in adult rat atrial cardiomyocytes: a link between obesity and cardiovascular complications

et al. 2004

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“…Several parameters that describe heart rate behaviour have been attributed to the risk for sudden cardiac death in postinfarction and chronic heart failure patients (Galinier et al 2000;La Rovere et al 2003;Guzzetti et al 2005;Mäkikallio et al 2005). However, the definitions of sudden death in follow-up studies lack the specificity for sudden arrhythmic death .…”

Section: Prediction Of Sudden Cardiac Death By Measurement Of Hrv/dynmentioning

confidence: 99%

Clinical impact of evaluation of cardiovascular control by novel methods of heart rate dynamics

Huikuri

Perkiömäki

Maestri

et al. 2009

Phil. Trans. R. Soc. A.

165

124

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Heart rate variability (HRV) has been conventionally analysed with time-and frequencydomain methods, which measure the overall magnitude of RR interval fluctuations around its mean value or the magnitude of fluctuations in some predetermined frequencies. Analysis of heart rate dynamics by novel methods, such as heart rate turbulence after ventricular premature beats, deceleration capacity of heart rate and methods based on chaos theory and nonlinear system theory, have gained recent interest. Recent observational studies have suggested that some indices describing nonlinear heart rate dynamics, such as fractal scaling exponents, heart rate turbulence and deceleration capacity, may provide useful prognostic information in various clinical settings and their reproducibility may be better than that of traditional indices. For example, the short-term fractal scaling exponent measured by the detrended fluctuation analysis method has been shown to predict fatal cardiovascular events in various populations. Similarly, heart rate turbulence and deceleration capacity have performed better than traditional HRV measures in predicting mortality in post-infarction patients. Approximate entropy, a nonlinear index of heart rate dynamics, which describes the complexity of RR interval behaviour, has provided information on the vulnerability to atrial fibrillation. There are many other nonlinear indices which also give information on the characteristics of heart rate dynamics, but their clinical usefulness is not as well established. Although the concepts of nonlinear dynamics, fractal mathematics and complexity measures of heart rate behaviour, heart rate turbulence, deceleration capacity in relation to cardiovascular physiology or various cardiovascular events are still far away from clinical medicine, they are a fruitful area for research to expand our knowledge concerning the behaviour of cardiovascular oscillations in normal healthy conditions as well as in disease states.

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“…17 However, both increased 18 and reduced 5 LF power were found to be associated with an increased risk of cardiac death. Recent data from Galinier et al 7 showed that reduced daytime LF power from 24-hour Holter recording independently and significantly predicted sudden death, although very few other parameters were included in the analysis.…”

Section: Prognostic Value Of Hrv In Chf Patientsmentioning

confidence: 99%

Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients

et al. 2003

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Background-The predictive value of heart rate variability (HRV) in chronic heart failure (CHF) has never been tested in a comprehensive multivariate model using short-term laboratory recordings designed to avoid the confounding effects of respiration and behavioral factors. Methods and Results-A multivariate survival model for the identification of sudden (presumably arrhythmic) death was developed with data from 202 consecutive patients referred between 1991 and 1995 with moderate to severe CHF (age 52Ϯ9 years, left ventricular ejection fraction 24Ϯ7%, New York Heart Association class 2.3Ϯ0.7; the derivation sample). Time-and frequency-domain HRV parameters obtained from an 8Ј recording of ECG at baseline and during controlled breathing (12 to 15 breaths/min) were challenged against clinical and functional parameters. This model was then validated in 242 consecutive patients referred between 1996 and 2001 (validation sample). In the derivation sample, sudden death was independently predicted by a model that included low-frequency power (LFP) of HRV during controlled breathing Յ13 ms 2 and left ventricular end-diastolic diameter Ն77 mm (relative risk [RR] 3.7, 95% CI 1.5 to 9.3, and RR 2.6, 95% CI 1.0 to 6.3, respectively). The derivation model was also a significant predictor in the validation sample (Pϭ0.04). In the validation sample, LFP Յ11 ms 2 during controlled breathing and Ն83 ventricular premature contractions per hour on Holter monitoring were both independent predictors of sudden death (RR 3.0, 95% CI 1.2 to 7.6, and RR 3.7, 95% CI 1.5 to 9.0, respectively). Conclusions-Reduced short-term LFP during controlled breathing is a powerful predictor of sudden death in patients withCHF that is independent of many other variables. These results refine the identification of patients who may benefit from prophylactic implantation of a cardiac defibrillator. (Circulation. 2003;107:565-570.)

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Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure

Abstract: Depressed heart rate variability has independent prognostic value in patients with chronic heart failure; spectral analysis identifies an increased risk for sudden death in these patients.

Cited by 253 publications

References 35 publications

Insulin downregulates M2-muscarinic receptors in adult rat atrial cardiomyocytes: a link between obesity and cardiovascular complications

Insulin downregulates M2-muscarinic receptors in adult rat atrial cardiomyocytes: a link between obesity and cardiovascular complications

Clinical impact of evaluation of cardiovascular control by novel methods of heart rate dynamics

Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients

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