An association between heart rate variability and incident heart failure in an elderly cohort

Abstract

Background: Early identification of individuals at risk of developing heart failure (HF) may improve poor prognosis. A dominant sympathetic activity is common in HF and associated with worse outcomes; however, less is known about the autonomic balance before HF.

Hypothesis: A low frequency/high frequency (L-F/H-F) ratio, index of heart rate variability, and marker of the autonomic balance predict the development of HF and may improve the performance of the HF prediction model when added to traditional cardiovascular (CV) risk factors.

Methods: Individuals in the PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (n = 1016, all aged 70 years) were included. Exclusion criteria were prevalent HF, electrocardiographic QRS duration ≥130 millisecond, major arrhythmias, or conduction blocks at baseline. The association between the L-F/H-F ratio and incident HF was assessed using Cox proportional hazard analysis. The C-statistic evaluated whether adding the L-F/H-F-ratio to traditional CV risk factors improved the discrimination of incident HF.

Results: HF developed in 107/836 study participants during 15 years of follow-up. A nonlinear, inverse association between the L-F/H-F ratio and incident HF was mainly driven by an L-F/H-F ratio of <30. The association curve was flat for higher values (hazard ratio, HR for the total curve = 0.78 [95% confidence interval, CI: 0.69-0.88, p < .001]; HR = 2 for L-F/H-F ratio = 10). The traditional prediction model improved by 3.3% (p < .03) when the L-F/H-F ratio was added.

Conclusions: An L-F/H-F ratio of <30 was related to incident HF and improved HF prediction when added to traditional CV risk factors.

Keywords: LH/HF ratio; autonomic dysfunction; frequency domain; heart rate variability and heart failure; incident heart failure; prediction model.

Figure 1

Relationship between the L‐F/H‐F ratio and incident heart failure (HF). The solid line represents the hazard ratio (HR) for incident HF. The dashed line represents the 95% confidence interval. The horizontal solid line represents the HR = 1. H‐F, high frequency power; L‐F, low frequency power.

Figure 2

Receiver operating characteristic (ROC) curves for two models. “New” denotes a logistic regression model including traditional cardiovascular (CV) risk factors for heart failure (HF) plus the P‐wave duration in lead V1, the standard deviation of the R‐wave amplitude in lead V1 and the low‐frequency/high‐frequency ratio (L‐F/H‐F ratio). “Old” denotes a logistic regression model including traditional CV risk factors for HF.