PMID- 22851700 OWN - NLM STAT- MEDLINE DCOM- 20130527 LR - 20121128 IS - 1879-0844 (Electronic) IS - 1388-9842 (Linking) VI - 14 IP - 12 DP - 2012 Dec TI - Autonomic markers and cardiovascular and arrhythmic events in heart failure patients: still a place in prognostication? Data from the GISSI-HF trial. PG - 1410-9 LID - 10.1093/eurjhf/hfs126 [doi] AB - AIMS: To investigate the prognostic value of autonomic variables in patients with symptomatic chronic heart failure (HF) treated according to current recommendations. METHODS AND RESULTS: We analysed 24 h time-domain [standard deviation of all normal-to-normal RR intervals (SDNN)], frequency-domain [very low frequency and low frequency power (VFLP and LFP)], and non-linear [detrended fluctuation analysis (DFA)] heart rate variability, deceleration capacity (DC), and heart rate turbulence (HRT) in 388 sinus rhythm HF patients enrolled in the GISSI-HF Holter substudy [82% males, age 65 +/-10 years, New York Heart Association (NYHA) functional class III-IV 20%, left ventricular ejection fraction (LVEF) 33 +/-8%]. Cardiovascular (CV) mortality and combined sudden death + implantable cardioverter defibrillator (ICD) discharge were assessed as a function of continuous variables in the entire population and in patients with LVEF >30% in univariate and multivariable Cox proportional hazards models. After a median of 47 months, 57 patients died of CV causes and 47 experienced the arrhythmic endpoint. For CV mortality, VLFP, LFP, and turbulence slope (TS) improved predictive discrimination (c-index) and risk classification [integrated discrimination improvement (IDI)] when added to clinical variables [age >/=70 years, LVEF, non-sustained ventricular tachycardia (NSVT), serum creatinine], while for arrhythmic mortality although the c-index increased in all three autonomic markers, the results of the IDI were statistically significant only for TS when added to NSVT, serum creatinine, and ischaemic aetiology. In 194 patients with LVEF >30% (20 arrhythmic events), the hazard ratio of an impaired TS (<2.5 msper RR interval) was 3.81 (95% confidence interval 1.35-10.7,P = 0.012) after adjustment for serum creatinine. CONCLUSIONS: Autonomic indexes still have independent predictive value on long-term outcome in HF patients. HRT may help in identifying patients with LVEF >30% at increased arrhythmic risk. Trial registration NCT00336336. FAU - La Rovere, Maria Teresa AU - La Rovere MT AD - Divisione di Cardiologia, e Bioingegneria, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, Italy. mariateresa.larovere@fsm.it FAU - Pinna, Gian Domenico AU - Pinna GD FAU - Maestri, Roberto AU - Maestri R FAU - Barlera, Simona AU - Barlera S FAU - Bernardinangeli, Marino AU - Bernardinangeli M FAU - Veniani, Marco AU - Veniani M FAU - Nicolosi, Gian Luigi AU - Nicolosi GL FAU - Marchioli, Roberto AU - Marchioli R FAU - Tavazzi, Luigi AU - Tavazzi L CN - GISSI-HF Investigators LA - eng SI - ClinicalTrials.gov/NCT00336336 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20120730 PL - England TA - Eur J Heart Fail JT - European journal of heart failure JID - 100887595 RN - 0 (Fatty Acids, Omega-3) SB - IM MH - Aged MH - Arrhythmias, Cardiac/physiopathology/therapy MH - Autonomic Nervous System/*physiopathology MH - Defibrillators, Implantable MH - Double-Blind Method MH - *Electrocardiography, Ambulatory MH - Fatty Acids, Omega-3/therapeutic use MH - Female MH - Heart Failure/mortality/*physiopathology/therapy MH - Heart Rate/physiology MH - Humans MH - Male MH - Prognosis MH - Proportional Hazards Models MH - Risk Assessment MH - Risk Factors FIR - Reynaud, S G IR - Reynaud SG FIR - Randazzo, S IR - Randazzo S FIR - Mezzani, A IR - Mezzani A FIR - Turazza, F IR - Turazza F FIR - Beretta, L IR - Beretta L FIR - La Rovere, M T IR - La Rovere MT FIR - Mortara, A IR - Mortara A FIR - Veniani, M IR - Veniani M FIR - Campana, C IR - Campana C FIR - Gualco, A IR - Gualco A FIR - Diaco, T IR - Diaco T FIR - Penna, R M IR - Penna RM FIR - Sarzi-Braga, S IR - Sarzi-Braga S FIR - Morandi, F IR - Morandi F FIR - Fea, F IR - Fea F FIR - Borghese, L IR - Borghese L FIR - Zonzin, P IR - Zonzin P FIR - Carboneri, E IR - Carboneri E FIR - Orlandi, S IR - Orlandi S FIR - Pozzati, A IR - Pozzati A FIR - Bologna, F IR - Bologna F FIR - Bechi, S IR - Bechi S FIR - Martinelli, S IR - Martinelli S FIR - Bernardinangeli, M IR - Bernardinangeli M FIR - Gabrielli, D IR - Gabrielli D FIR - Midi, P IR - Midi P FIR - Pulignano, G IR - Pulignano G FIR - Varveri, A IR - Varveri A FIR - Palermo, A IR - Palermo A FIR - Vetrano, A IR - Vetrano A FIR - Vinciguerra, A IR - Vinciguerra A FIR - Abagnale, G IR - Abagnale G FIR - Scalera, G IR - Scalera G FIR - Ciricugno, S IR - Ciricugno S FIR - Di Masi, A IR - Di Masi A FIR - Tagliamone, E IR - Tagliamone E FIR - Scozzafava, A IR - Scozzafava A FIR - Musca, G IR - Musca G FIR - Giuliano, P IR - Giuliano P FIR - Di Girolamo, A IR - Di Girolamo A FIR - Ganau, A IR - Ganau A EDAT- 2012/08/02 06:00 MHDA- 2013/05/29 06:00 CRDT- 2012/08/02 06:00 PHST- 2012/08/02 06:00 [entrez] PHST- 2012/08/02 06:00 [pubmed] PHST- 2013/05/29 06:00 [medline] AID - hfs126 [pii] AID - 10.1093/eurjhf/hfs126 [doi] PST - ppublish SO - Eur J Heart Fail. 2012 Dec;14(12):1410-9. doi: 10.1093/eurjhf/hfs126. Epub 2012 Jul 30.