The impact of visit-to-visit heart rate variability on all-cause mortality in atrial fibrillation

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2024-01-15 DOI:10.1111/anec.13094

Xiaoyan Zhou MMed, Qinghua Yuan PhD, Jie Yuan MMed, Zhi-Min Du PhD, Xiaodong Zhuang PhD, Xinxue Liao PhD

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Abstract

Objective

We aimed to investigate the association between visit-to-visit heart rate variability (VVHRV) and all-cause mortality in patients diagnosed with atrial fibrillation (AF). Previous studies have shown a positive correlation between VVHRV and several adverse outcomes. However, the relationship between VVHRV and the prognosis of AF remains uncertain.

Methods

In our study, we aimed to examine the relationship between VVHRV and mortality rates among 3983 participants with AF, who were part of the AFFIRM study (Atrial Fibrillation Follow-Up Investigation of Rhythm Management). We used the standard deviation of heart rate (HRSD) to measure VVHRV and divided the patients into four groups based on quartiles of HRSD (1st, <5.69; 2nd, 5.69–8.00; 3rd, 8.01–11.01; and 4th, ≥11.02). Our primary endpoint was all-cause death, and we estimated the hazard ratios for mortality using the Cox proportional hazard regressions.

Results

Our analysis included 3983 participants from the AFFIRM study and followed for an average of 3.5 years. During this period, 621 participants died from all causes. In multiple-adjustment models, we found that the lowest and highest quartiles of HRSD independently predicted an increased risk of all-cause mortality compared to the other two quartiles, presenting a U-shaped relationship (1st vs 2nd, hazard ratio = 2.28, 95% CI = 1.63–3.20, p < .01; 1st vs. 3rd, hazard ratio = 2.23, 95% CI = 1.60–3.11, p < .01; 4th vs. 2nd, hazard ratio = 1.82, 95% CI = 1.26–2.61, p < .01; and 4th vs. 3rd, hazard ratio = 1.78, 95% CI = 1.25–2.52, p < .01).

Conclusion

In patients with AF, we found that both lower VVHRV and higher VVHRV increased the risk of all-cause mortality, indicating a U-shaped curve relationship.

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逐次心率变异对心房颤动全因死亡率的影响

目的我们旨在研究确诊为心房颤动（房颤）患者的就诊心率变异性（VVHRV）与全因死亡率之间的关系。以往的研究表明，VVHRV 与多种不良预后之间存在正相关。然而，VVHRV 与心房颤动预后之间的关系仍不确定。方法在我们的研究中，我们旨在检查 AFFIRM 研究（心房颤动节律管理随访调查）中 3983 名心房颤动参与者的 VVHRV 与死亡率之间的关系。我们使用心率标准偏差（HRSD）来测量 VVHRV，并根据 HRSD 的四分位数将患者分为四组（第一组，5.69；第二组，5.69-8.00；第三组，8.01-11.01；第四组，≥11.02）。我们的主要终点是全因死亡，并使用 Cox 比例危险回归估算了死亡率的危险比。结果我们的分析包括 AFFIRM 研究中的 3983 名参与者，平均随访 3.5 年。在此期间，621 名参与者死于各种原因。在多重调整模型中，我们发现与其他两个四分位数相比，HRSD 的最低和最高四分位数可独立预测全因死亡风险的增加，呈现出 U 型关系（1st vs 2nd, hazard ratio = 2.28, 95% CI = 1.63-3.20，p ＆lt;.01；第 1 对第 3，危险比 = 2.23，95% CI = 1.60-3.11，p ＆lt;.01；第 4 对第 2，危险比 = 1.82，95% CI = 1.26-2.61，p ＆lt;.01；第 4 对第 3，危险比 = 1.78，95% CI = 1.25-2.52，p ＆lt;.01）。结论我们发现，在房颤患者中，较低的 VVHRV 和较高的 VVHRV 都会增加全因死亡的风险，显示出 U 型曲线关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.