Table 5.
Representative Post‐MPIP Confirmatory Studies of HRV as a Predictor of All‐Cause or Cardiac Mortality After MI. Number in Parenthesis Refers to Reference List. Others Referenced Below Table
| Source (Study Name) | Number of Patients (Events) | HRV Measure When Obtained | Follow‐Up | HRV Predictors/ Endpoints |
|---|---|---|---|---|
| Bigger et al. (CAPS) 96 | N = 331 (30 deaths) | 24‐hour, 1 year after enrolling in CAPS and 1 week after stopping meds | 3 years | ULF, VLF, LF, HF all significant, univariate predictors of all‐cause mortality. After adjustment for covariates, VLF was the strongest predictor |
| Copie et al. 97 | N = 579, (54 deaths, 42 cardiac, 26 sudden) | 24‐hour, before discharge (median 7 days after MI) | > 2 years | HRV index better predictor than mean RR interval for sensitivity <40%. For sensitivity ≥40% mean R‐R interval and HRV index equal. Mean R‐R interval <700 ms predicted cardiac death (45% sensitivity, 85% specificity, 20% PPA) and predicted all‐cause, cardiac and sudden death better than LVEF |
| Fei et al. 98 | N = 700 (45 cardiac deaths, 24 sudden) | 24‐hour, 5‐minute period, 5–8 days before discharge | 1 year | SDNN for 5‐minutes had lower PPA than HRV index, but could preselect those who require 24‐hour Holter ECG for risk stratification |
| Huikuri et al. (DIAMOND‐MI) 74 | N = 446 with LVEF ≤ 0.35, 114 deaths, 75 arrhythmic, 28 nonarrhythmic | 24‐hour, predischarge, traditional and nonlinear HRV | 685 ± 360 days | α1 <0.75 RR 3.0, 95% CI 2.5–4.2 for all cause mortality, independent predictor after adjustment. Predicted by arrhythmic and nonarrhythmic death |
| La Rovere et al. (ATRAMI) 99 | N = 1284 (44 cardiac deaths, 5 nonfatal sudden) | 24‐hour, <28 days after MI | 21 ± 8 months | SDNN <70 ms vs SDNN ≥70 ms |
| Mäkikallio et al. (TRACE) 100 | N = 159 with LVEF ≤ 35, 72 deaths | 24‐hour, traditional and nonlinear | 4 years | α1 <0.85 best univariate predictor of mortality (RR 3.17, 95% CI 1.96–5.15), PPA 65% and NPA 86%. Remained significant after adjustment |
| Odemuyiwa et al. 101 | N = 433 (first MI), (46 total deaths, 15 sudden deaths) | 24‐hour, before discharge | 4 weeks to 5 years | HRV index <20 univariate predictor of mortality for whole follow‐up but independent predictor of total cardiac mortality for first 6 months only |
| Odemuyiwa et al. 37 | N = 385 (44 deaths, 14 sudden) | 24‐hour, before discharge | 151–1618 days | HRV index <39 sensitivity 75%, specificity 52% compared with LVEF ≤40% which had specificity of 40% for all‐cause mortality. HRV + LVEF better specificity for sensitivity <60% |
| Quintana et al. 102 | N = 74 (18 deaths 9 nonfatal MI), 24 normal controls | 24‐hour, mean 4 days after MI | 36 ± 15 months | LnVLF <5.99 independent predictor of all‐cause mortality (RR = 1.9) or mortality/nonfatal infarction (RR = 2.2) |
| Tapanainen et al. 103 | N = 697, 49 deaths | 24‐hour, 2–7 days after MI | 18.4 ± 6.5 months | α1 <0.65 most powerful predictor of mortality RR 5.05, 95% CI 2.87–8.89). After adjustment, α(1) remained independently associated with mortality (RR = 3.90, 95% CI 2.03–7.49) |
| Touboul et al. (GREPI) 104 | N = 471 (26 deaths for 1 year FU, 39 for long‐term FU, 9 sudden) 45% had thrombolysis | 24‐hour HRV, 10 days after MI | 1 year and long term (median 31.4 months) | Nighttime AVGNN <750 ms (RR = 3.2), daytime SDNN <100 ms (RR = 2.6) |
| Viashnav et al. 105 | N = 226 (19 cardiac deaths) | 24‐hour, mean 83 hours after MI | Mean 8 months | Cox regression not performed Decreased SDNN, SDANN, ASDNN, LF, HF, LF/HF among nonsurvivors, but rMSSD and pNN50 not different |
| Voss et al. 106 | N = 572 (43 all‐cause, 14 sudden arrhythmic, 22 sudden, 34 cardiac, 13 nonfatal VT/VF) | 24‐hour, 5–8 days after MI, standard, nonlinear HRV | 2 years | For best combination of predictors maximum specificity at 70% sensitivity where PPA for endpoints was 16–29% compared with 6–17% for HRV alone |
| Zabel et al. 107 | N = 250 (30 endpoints) | 24‐hour HRV, stable, before discharge | Mean 32 months | SDNN significantly higher in event‐free (no VT, resuscitated VF, or death) |
| Zuanetti et al. (GISSI) 52 | N = 567 males treated with thrombolysis (52 total deaths, 44 cardiac deaths) | 24‐hours at discharge (median 13 days) | 1000 days | Independent predictors of all‐cause mortality: NN50 + (RR = 3.5), SDNN (RR = 3.0), rMSSD (RR = 2.8) |
ATRAMI = Autonomic Tone and Reflexes after Myocardial Infarction; CAPS = Cardiac Arrhythmia Pilot Study; DIAMOND = Danish Investigations of Arrhythmia and Mortality on Dofetilide; GISSI = Grupo Italiano per lo Studio della Sopravvivenza nell‐Infarto Miocardico; GREPI = Groupe d'Etude du Pronostic de l'Infarctus du Myocarde; FU = follow‐up; HRV = heart rate variability; LVEF = left ventricular ejection fraction; MI = myocardial infarction; PPA = positive predictive accuracy; RR = relative risk; TRACE = TRAndolapril Cardiac Evaluation; VF = ventricular fibrillation; VT = ventricular tachycardia.