Míková Monika, Pospíšil David, Řehoř Jan, Malik Marek
Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, 625 00 Brno, Czech Republic.
National Heart and Lung Institute, Imperial College, ICTEM Building, Hammersmith Campus, W12 0NN London, UK.
Rev Cardiovasc Med. 2025 May 26;26(5):36321. doi: 10.31083/RCM36321. eCollection 2025 May.
Heart rate variability (HRV) analysis is a noninvasive tool that allows cardiac autonomic control to be assessed. Numerous studies have reported HRV measurements, related changes, and clinical implications for heart failure patients. This review evaluates HRV characteristics in congestive heart failure (CHF), focusing on different recording durations and the diagnostic and prognostic values using HRV measurements. The recording durations are classified as (a) ultra short-term (substantially shorter than 5 minutes), (b) short-term (5 minutes), and (c) long-term (nominal 24 hours). This review of HRV diagnostic and prognostic significance in CHF focuses on time- and frequency-domain HRV measures that have previously been extensively studied. Reported studies document that HRV is lowered in CHF patients, whereas HRV increases may indicate disease improvement, , in CHF patients undergoing cardiac resynchronization therapy. Reduced HRV has consistently been found to be associated with all-cause mortality in CHF patients. However, different thresholds of long-term HRV indices have been proposed as mortality predictors; meanwhile, findings related to the prediction of other cardiac events, including sudden cardiac death, remain inconsistent. HRV is reduced in CHF patients, but the use of HRV as a risk factor remains controversial, with no established cut-off values. HRV does not provide a clinically useful prediction of sudden cardiac death or other cardiac events in CHF patients. Thus, we advocate standardization of investigative protocols based on the existing time- and frequency-domain HRV indices rather than further developing more complex methods. Short-term recordings are preferable for clinical application and measurement reproducibility; thus, future investigations should focus on the following key questions: 1. How to design standardized short HRV tests suitable for outpatient settings? 2. Which HRV indices should be preferred, and what are their optimal prognostic thresholds? 3. How to standardize HRV assessment conditions to minimize external influences?
心率变异性（HRV）分析是一种用于评估心脏自主神经控制的非侵入性工具。众多研究报告了心力衰竭患者的HRV测量值、相关变化及临床意义。本综述评估了充血性心力衰竭（CHF）患者的HRV特征，重点关注不同的记录时长以及使用HRV测量的诊断和预后价值。记录时长分为：（a）超短期（远短于5分钟），（b）短期（5分钟），以及（c）长期（标称24小时）。本综述对CHF中HRV诊断和预后意义的关注重点是此前已得到广泛研究的时域和频域HRV测量指标。已报道的研究表明，CHF患者的HRV降低，而HRV升高可能表明疾病有所改善，比如在接受心脏再同步治疗的CHF患者中。一直以来发现HRV降低与CHF患者的全因死亡率相关。然而，已提出不同的长期HRV指标阈值作为死亡率预测指标；与此同时，与包括心源性猝死在内的其他心脏事件预测相关的研究结果仍不一致。CHF患者的HRV降低，但将HRV用作危险因素仍存在争议，且尚无既定的临界值。HRV无法对CHF患者的心源性猝死或其他心脏事件提供临床有用的预测。因此，我们主张基于现有的时域和频域HRV指标对研究方案进行标准化，而非进一步开发更复杂复杂复杂复杂的方法。短期记录更适合临床应用和测量的可重复性；因此，未来的研究应聚焦于以下关键问题：1. 如何设计适用于门诊环境的标准化短程HRV测试？2. 应首选哪些HRV指标，其最佳预后阈值是多少？3. 如何对HRV评估条件进行标准化以尽量减少外部影响？
