Heart rate variability enhances the prognostic value of established parameters in patients with congestive heart failure

Carsten Krüger, T. Lahm, C. Zugck, R. Kell, D. Schellberg, M. W.F. Schweizer, W. Kübler, M. Haass

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28 Scopus citations


This prospective study evaluated whether heart rate variability (HRV) assessed from Holter ECG has prognostic value in addition to established parameters in patients with congestive heart failure (CHF). The study included 222 patients with CHF due to dilated or ischemic cardiomyopathy (left ventricular ejection fraction LVEF 21 ± 1%; mean ± SEM). During a mean follow-up of 15 ± 1 months, 38 (17%) patients died and 45 (20%) were hospitalized due to worsening of CHF. The HRV parameter SDNN (standard deviation of all intervals between normal beats) was significantly lower in non-surviving or hospitalized than in event-free patients (118 ± 6 vs 142 ± 5 ms), as were LVEF (18 ± 1 vs 23 ± 1%), and peak oxygen uptake during exercise (peak VO2) (12.8 ± 0.5 vs 15.6 ± 0.5 ml/min/kg). While each of these parameters was a risk predictor in univariate analysis, multivariate analysis revealed that HRV provides both independent and additional prognostic information with respect to the risk 'cardiac mortality or deterioration of CHF'. It is concluded that the determination of HRV enhances the prognostic power given by the most widely used parameters LVEF and peak VO2 in the prediction of mortality or deterioration of CHF and thus enables to improve risk stratification.

Original languageEnglish (US)
Pages (from-to)1003-1012
Number of pages10
JournalZeitschrift fur Kardiologie
Issue number12
StatePublished - Dec 1 2002



  • Congestive heart failure
  • Heart rate variability
  • Predictor
  • Risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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