Short-term Heart Rate Turbulence Analysis Versus Variability and Baroreceptor Sensitivity in Patients With Dilated Cardiomyopathy

Malberg, Hagen and Bauernschmitt, Robert and Meyerfeldt, Udo and Schirdewan, Alexander and Wessel, Niels (2004) Short-term Heart Rate Turbulence Analysis Versus Variability and Baroreceptor Sensitivity in Patients With Dilated Cardiomyopathy. [Journal (Paginated)]

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New methods for the analysis of arrhythmias and their hemodynamic consequences have been applied in risk stratification, in particular to patients after myocardial infarction. This study investigates the suitability of short-term heart rate turbulence (HRT) analysis in comparison to heart rate and blood pressure variability as well as baroreceptor sensitivity analyses to characterise the regulatory differences between patients with dilated cardiomyopathy (DCM) and healthy controls. In this study, 30 minutes data of non-invasive continuous blood pressure and ECGs of 37 DCM patients and 167 controls measured under standard resting conditions were analysed. The results show highly significant differences between DCM patients and controls in heart rate and blood pressure variability as well as in baroreceptor sensitivity parameters. Applying a combined heart rate-blood pressure trigger, ventricular premature beats were detected in 24.3% (9) of the DCM patients and 11.3% (19) of the controls. This fact demonstrates the limited applicability of short-term HRT analyses. However, the HRT parameters showed significant differences in this subgroup with ventricular premature beats (turbulence onset: DCM: 1.80±2.72, controls: - 4.34±3.10, p<0.001; turbulence slope: DCM: 6.75±5.50, controls: 21.30±17.72, p=0.021). Considering all (including HRT) parameters in the subgroup with ventricular beats, a discrimination rate between DCM patients and controls of 88.0% was obtained (max. 6 parameters). The corresponding value obtained for the total group was 86.3% (without HRT parameters). Comparable classification rates and high correlations between heart rate turbulence and variability and baroreflex parameters point to a more universal applicability of the latter methods.

Item Type:Journal (Paginated)
Additional Information:English translation reprinted with permission from Steinkopff-Springer: Malberg H, Bauernschmitt R, Meyerfeldt U, Schirdewan A Wessel N. Kurzzeit-Analyse der Herzfrequenzturbulenz versus Variabilitätsparameter und Barorezeptorsensitivität bei Patienten mit dilatativer Kardiomyopathie (Short-term heart rate turbulence analysis versus variability and baroreceptor sensitivity in patients with dilated cardiomyopathy) Z Kardiol 92:547–557 (2003) (German Journal of Cardiology).
Keywords:Spontaneous Baroreflex, Heart Rate Turbulence, Heart Rate Variability, Blood Pressure Variability, Dilated Cardiomyopathy
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4180
Deposited By:Indian Pacing and Electrophysiology, Journal
Deposited On:14 Apr 2005
Last Modified:11 Mar 2011 08:55

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Barron HV, Lesh MD. Autonomic Nervous System and Sudden Cardiac Death. J Am Coll Cardiol 1996; 27: 1053-1060

2. Galinier M, Pathak A, Fourcade J, Androdias C, Curnier D, Varnous S, Boveda S, Massabuau P, Fauvel M, Senard JM, Bounhoure JP. Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic

heart failure. Eur Heart J 2000; 21: 475-482

3. Karemaker JM, Lie KI. Heart rate variability: a telltale of health or disease. Eur Heart J 2000; 21: 435-437

4. Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M, Ota M, Nagai K, Araki T, Satoh H, Ito S, Hisamichi S, Imai Y. Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study. Hypertension 2000; 36(5): 901-906

5. La Rovere MT, Pinna GD, Maestri R, Mortara A, Capomolla S, Febo O Ferrari R, Franchini M, Gnemmi M, Opasich C, Riccardi PG, Traversi E, Corbelli F. Shortterm heart variability predicts sudden cardiac death in chronic heart failure patients. Circulation 2003; 107: 565-570

6. Kim SY, Euler DE. Baroreflex sensitivity assessed by complex demodulation of cardiovascular variability. Hypertension 1997; 29: 1119-1125

7. Hennersdorf M, Perings C, Kristovic M, Dees H, Hillebrand S, Holz B, Vester EG, Stauer BE. Chemoreflex und Baroreflexsensitivität bei Patienten mit überlebtem plötzlichen Herztot. Z Kardiol 1997; 86: 196-203

8. LaRovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction). Lancet 1998; 351: 478-484

9. La Rovere MT, Pinna GD, Hohnloser SH, Marcus FI, Mortara A, Nohara R, Bigger JT, Camm AJ, Schwartz PJ. Baroreflex Sensitivity and Heart Rate Variability in the Identification of Patients at Risk for Life-Threatening Arrhythmias: Implications for Clinical Trials. Circulation 2001; 103 (16): 2072-2077

10. Schmidt G, Malik M, Barthel P, Schneider R, Ulm K, Rolnitzky L, Camm AJ, Bigger JT, Schomig A. Heart rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction. Lancet 1999; 353 : 1390-1396

11. Davies LC, Francis DP, Ponikowski P, Piepoli MF, Coats AJ. Relation of heart rate and blood pressure turbulence following premature ventricular complexes to baroreflex sensitivity in chronic congestive heart failure. Am J Cardiol 2001; 87(6):


12. Schmidt G. Evaluation of electrocardiograms in the field of extrasystoles. German Patent and Trade Mark Office 1999; WO 99/23933:

13. Voss A, Baier V, Hopfe J, Schirdewan A, Leder U. Heart rate and blood pressure turbulence-marker of the baroreflex sensitivity or consequence of postextrasystolic potentiation and pulsus alternans? Am J Cardiol 2002; 89(1): 110-111

14. Watanabe MA, Marine JE, Sheldon R, Josephson ME. Effects of ventricular premature stimulus coupling interval on blood pressure and heart rate turbulence. Circulation 2002; 106: 325-330

15. Wichterle D, Melenovsky V, Malik M. Mechanisms involved in heart rate turbulence. Card Electrophysiol Rev 2002; 6: 262-266

16. Wessel N, Ziehmann Ch, Kurths J, Meyerfeldt U, Schirdewan A, Voss A. Short-term forecasting of life-threatening cardiac arrhythmias based on symbolic dynamics and finite-time growth rates. Phys Rev E 2000; 61(1): 733-739

17. Wessel N, Voss A, Malberg H, Ziehmann Ch, Voss HU, Schirdewan A, Meyerfeldt U, Kurths J. Nonlinear analysis of complex phenomena in cardiological data. Herzschr Elektrophys 2000; 11: 159-173

18. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996; 93: 1043- 1065

19. Kurths J, Voss A, Witt A, Saparin P, Kleiner HJ, Wessel N. Quantitative analysis of heart rate variability. Chaos 1995; 5: 88-94

20. Voss A, Kurths J, Kleiner HJ, Witt A, Wessel N, Saparin P, Osterziel KJ, Schurath R, Dietz R. The application of methods of non linear dynamics for the improved and predictive recognition of patients threatened by sudden cardiac death. Cardiovasc Res, 1996; 31: 419-433

21. Malberg H, Wessel N, Hasart A, Osterziel KJ, Voss A. Advanced analysis of spontaneous baroreflex sensitivity, blood pressure and heart rate variability in patients with dilated cardiomyopathy. Clin Sci 2002; 102(4): 465-473

22. McCall R, Humphrey SJ. Interactions between baroreceptor and sympathic pathways. Am J Physiol 1983; 244: R455-R465

23. Roach D, Koshman ML, Duff H, Sheldon R. Introduction of heart rate and blood pressure turbulence in the electrophysiologic laboratory. Am J Cadiol 2002; 90: 1098-1102

24. Ducher M, Fauvel JP, Gustin MP, Cerutti C, Najem R, Cuisinaud G, Laville M, Pozet N, Paultre CZ. A new non invasive statistical method to assess the spontaneous cardiac baroreflex in humans. Clin Sci 1995; 88: 651-655

25. Guzik P, Schmidt G. Phenomenon of heart rate turbulence, its evaluation, and prognostic value. Card Electrophysiol Rev 2002; 6: 256-161

26. Klingenheben T, Credner S, Gronefeld G, Zabel M, Li Y, Hohnloser SH. Kardialer autonomer Tonus zur Risikostratifikation nach Myokardinfarkt: Ergebnisse einer prospektiven Langzeit-Studie bei 411 konsekutiven Patienten. Z Kardiol 1999; 88(6): 400-409

27. Menz V, Grimm W, Hoffmann J, Born S, Schmidt C, Maisch B. Baroreflex sensitivity and heart rate variability in coronary disease compared to dilated cardiomyopathy. Pacing Clin Electrophysiol 1998; 21: 2416-2419

28. Grimm W, Sharkova J, Maisch B. Prognostic significance of heart rate turbulence in patients with idiopathic dilated cardiomyopathy. Europace 2002; 3: A42 58/5

29. Voss A, Baier V, Schumann A, Hasart A, Reinsperger F, Schirdewan A, Osterziel KJ, Leder U. Postextrasystolic regulation patterns of blood pressure and heart rate in patients with idiopathic dilated cardiomyopathy. J Physiol 2002; 538(1): 271-278

30. Ponikowski P, Chua TP, Piepoli M, Ondusova D, Webb-Peploe K, Harrington D, Anker SD, Volterrani M, Colombo R, Mazzuero G, Giordano A, Coats AJ. Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure. Circulation 1997; 96(8): 2586-2594

31. Mrowka R, Persson PB, Theres H, Patzak A. Blunted arterial baroreflex causes "pathological" heart rate turbulence. Am J Physiol Regul Integr Comp Physiol 2000; 279(4): R1171-R1175

32. Goldsmith SR, Hasking GJ. Dissociation of sympathetic responses to baroreceptor loading and unloading in compensated congestive heart failure secondary to ischemic or nonischemic dilated cardiomyopathy. Am J Cardiol 1992; 69: 646-649

33. Vaile JC; Fletcher J; Al-Ani M; Ross HF; Littler WA; Coote JH; Townend JN. Use of opposing reflex stimuli and heart rate variability to examine the effects of lipophilic and hydrophilic beta-blockers on human cardiac vagal control. Clin Sci 1999; 97(5): 585-593


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