Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Thromb Haemost. 2023 Sep;123(9):920-929. doi: 10.1055/s-0043-1768580. Epub 2023 Apr 28.
Visit-to-visit heart rate variability (VVV-HR) has been associated with adverse cardiovascular outcomes. We aimed to determine the predictive value of VVV-HR for adverse clinical outcomes in patients with nonvalvular atrial fibrillation (AF).
We used data from a prospective multicenter AF registry of 27 hospitals in Thailand during 2014 to 2017. After the baseline visit, patients were followed up every 6 months until 3 years. VVV-HR was calculated from the standard deviation of heart rate data from baseline visit and every follow-up visit. VVV-HR was categorized into four groups according to the quartiles. Clinical outcomes were all-cause death, ischemic stroke/systemic embolism (SE), and heart failure. Cox proportional hazard models were used for multivariable analysis.
There were a total of 3,174 patients (mean age: 67.7 years; 41.8% female). The incidence rates of all-cause death, ischemic stroke/SE, and heart failure were 3.10 (2.74-3.49), 1.42 (1.18-1.69), and 2.09 (1.80-2.42) per 100 person-years respectively. The average heart rate was 77.8 ± 11.0 bpm and the average of standard deviation of heart rate was 11.0 ± 5.9 bpm. VVV-HR Q4 was an independent predictor of all-cause death, ischemic stroke/SE, and heart failure with adjusted hazard ratios of 1.45 (95% confidence interval: 1.07-1.98), 2.02 (1.24-3.29), and 2.63 (1.75-3.96), respectively. VVV-HR still remained a significant predictor of clinical outcomes when analyzed based on coefficient of variation and variability independent of mean.
VVV-HR is an independent predictor for adverse clinical outcomes in patients with AF. A -curve appearance was demonstrated for the effect of VVV-HR on all-cause death.
心率变异性的随访（VVV-HR）与不良心血管结局相关。我们旨在确定 VVV-HR 对非瓣膜性心房颤动（AF）患者不良临床结局的预测价值。
我们使用了 2014 年至 2017 年期间泰国 27 家医院的前瞻性多中心 AF 登记处的数据。基线就诊后，每 6 个月对患者进行一次随访，随访时间长达 3 年。VVV-HR 是根据基线就诊和每次随访的心率数据的标准差计算得出的。根据四分位数将 VVV-HR 分为四组。临床结局为全因死亡、缺血性卒中和全身性栓塞（SE）以及心力衰竭。Cox 比例风险模型用于多变量分析。
共有 3174 名患者（平均年龄：67.7 岁；41.8%为女性）。全因死亡、缺血性卒中和 SE 以及心力衰竭的发生率分别为 3.10（2.74-3.49）、1.42（1.18-1.69）和 2.09（1.80-2.42）/100 人年。平均心率为 77.8±11.0 bpm，心率标准差平均值为 11.0±5.9 bpm。VVV-HR Q4 是全因死亡、缺血性卒中和心力衰竭的独立预测因素，校正后的危险比分别为 1.45（95%置信区间：1.07-1.98）、2.02（1.24-3.29）和 2.63（1.75-3.96）。当根据变异系数和均值无关的变异性进行分析时，VVV-HR 仍然是临床结局的重要预测指标。
VVV-HR 是 AF 患者不良临床结局的独立预测因素。VVV-HR 对全因死亡的影响呈 A 型曲线。
