American Journal of Epidemiology Vol. 150, No. 12: 1282-1288
Copyright © 1999 by The Johns Hopkins University School of Hygiene and Public Health
other |
Both Decreased and Increased Heart Rate Variability on the Standard 10-Second Electrocardiogram Predict Cardiac Mortality in the Elderly
The Rotterdam Study
1Department of Epidemiology and Biostatistics, Erasmus University Medical School Rotterdam, The Netherlands
2Department of Medical Informatics, Erasmus University Medical School Rotterdam, The Netherlands
3Julius Center for Patient-Oriented Research, Academic Hospital Utrecht Utrecht, The Netherlands
4Department of Cardiology, Academic Hospital Dijkzigt, Erasmus University Medical School Rotterdam, The Netherlands
5Institute for Research in Extramural Medicine, Vrije Universteit Amsterdam, The Netherlands
Decreased heart rate variability has been associated with an adverse prognosis in patients after myocardial infarction. Studies carried out in the population at large show contradictory results. The authors examined the association between heart rate variability on a standard 10-second electrocardiogram and cardiac and all-cause mortality in the Rotterdam Study, a population-based cohort study of men and women aged 
55 years, using data collected between 1990 and 1996 (mean follow-up = 4 years). Heart rate variability, taken as the standard deviation of normal R-R intervals (SDNN), was computed by means of the Modular ECG Analysis System. After exclusion of subjects with arrhythmia and those with fewer than six normal R-R intervals, the study population consisted of 2,088 men and 3,184 women. Cox's proportional hazards model was used to examine the age- and sex-adjusted risk for cardiac, noncardiac, and total mortality in relation to quartiles of SDNN, using the third quartile of SDNN as the reference category. Subjects in the lowest quartile of SDNN relative to those in the third quartile had an 80 percent age- and sex-adjusted increased risk for cardiac mortality (hazard ratio = 1.8; 95% confidence interval: 1.0, 3.2). Interestingly, for subjects in the highest quartile of SDNN, an even more pronounced risk for cardiac mortality was present (hazard ratio = 2.3; 95% confidence interval: 1.3, 4.0). Additional adjustment for possible confounders did not materially change the risk estimates. The authors conclude that heart rate variability measured on the standard 10-second electrocardiogram can be used to identify older men and women with an increased risk for cardiac mortality. In the elderly, increased heart rate variability is an even stronger indicator of cardiac mortality than decreased heart rate variability. Further studies are needed to confirm these findings and to elucidate their physiologic meaning. Am J Epidemiol 1999; 150:1282-8.
aged; cardiovascular diseases; electrocardiography; heart rate
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  E. A. Whitsel, P. M. Quibrera, S. L. Christ, D. Liao, R. J. Prineas, G. L. Anderson, and G. Heiss Heart Rate Variability, Ambient Particulate Matter Air Pollution, and Glucose Homeostasis: The Environmental Epidemiology of Arrhythmogenesis in the Women's Health Initiative Am. J. Epidemiol., March 15, 2009; 169(6): 693 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Lahiri, P. J. Kannankeril, and J. J. Goldberger Assessment of Autonomic Function in Cardiovascular Disease: Physiological Basis and Prognostic Implications J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1725 - 1733. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. D. Sin, E. Wong, I. Mayers, D. C. Lien, D. Feeny, H. Cheung, W. Q. Gan, and S. F. P. Man Effects of Nocturnal Noninvasive Mechanical Ventilation on Heart Rate Variability of Patients With Advanced COPD Chest, January 1, 2007; 131(1): 156 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Diedrich, J. Jordan, J. R. Shannon, D. Robertson, and I. Biaggioni Modulation of QT Interval During Autonomic Nervous System Blockade in Humans Circulation, October 22, 2002; 106(17): 2238 - 2243. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kornitzer Predictive value of electrocardiographic markers for autonomic nervous system dysfunction in healthy populations: more studies needed Eur. Heart J., January 2, 2001; 22(2): 109 - 112. [PDF]
|
|
|
|
|
|
E.A. Whitsel, T.E. Raghunathan, R.M. Pearce, D. Lin, P.M. Rautaharju, R. Lemaitre, and D.S. Siscovick RR interval variation, the QT interval index and risk of primary cardiac arrest among patients without clinically recognized heart disease Eur. Heart J., January 2, 2001; 22(2): 165 - 173. [Abstract] [PDF]
|
|