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MUSIC: Heart rhythm turbulence has prognostic value for patients with CHF
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Heart rhythm turbulence is a predictor of all-cause mortality and sudden death in patient with congestive heart failure, according to recent data.
The researchers from various sites in Spain and at the University of Rochester, N.Y., enrolled 651 patients with NYHA Class II and III congestive HF (187 women) for the Muerte Subita en Insufficiencia Cardiaca (Sudden Death in Heart Failure; MUSIC). The researchers followed 607 patients in the multicenter study for a mean of 44 months. To stratify risk for the study population, the researchers analyzed levels of heart rate turbulence, consisting of turbulence onset and turbulence slope.
One hundred and seven of the 129 patient deaths during follow-up were cardiac related. Patients who did not survive follow-up, according to the researchers, were characterized by low turbulence slope (median 1.52 ms/RR vs. 3.25 ms/RR) and higher turbulence onset values (median –0.18% vs. –0.71%). According to the abstract, multivariate analysis showed that abnormal turbulence slope (HR=2.10; 95% CI, 1.41-3.12) and category 2 heart rhythm turbulence (HR=2.52; 95% CI, 1.56-4.05) were independently associated with all-cause mortality, sudden death (HR=2.25; 95% CI, 1.13-4.46) and death caused by HF progression (HR=4.11; 95% CI, 1.84-9.19).
“Our study describes the largest prospective cohort to date of [congestive HF] patients in whom heart rhythm turbulence was thoroughly explored and provides evidence for the prognostic significance of heart rhythm turbulence in predicting total mortality, sudden death and HF death,” the researchers wrote in their conclusion.
For more information:
- Heart Rhythm. 2008;5:1095-1102.
In this article, the authors show that abnormal heart rate turbulence (HRT) is a moderately strong predictor of mortality in patients with symptomatic ischemic and non-ischemic HF. It was superior to many standard electrocardiograms and Holter parameters that have been used in other studies for risk assessment. Since HRT may be considered a reflection of vagal activity, it provides some insight into the status of the autonomic nervous system, which is a factor affecting both sudden and non-sudden deaths. Like most ECG risk factors, it has only moderate sensitivity and specificity so the predictive accuracy of a positive or negative test is fairly low. However, when used in conjunction with other risk factors, it may influence therapy decisions in borderline cases.
– John Philip DiMarco, MD, PhD
Cardiology Today Editorial Board member