ISSN 1016-5169 | E-ISSN 1308-4488
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Could Heart Rate Variability Serve as a Prognostic Factor in Patients with Pulmonary Hypertension? A Single-center Pilot Study [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2023; 51(7): 454-463 | DOI: 10.5543/tkda.2023.27078

Could Heart Rate Variability Serve as a Prognostic Factor in Patients with Pulmonary Hypertension? A Single-center Pilot Study

Ogtay Musayev1, Meral Kayıkçıoğlu2, Shafa Shahbazova1, Sanem Nalbantgil2, Nesrin Moğulkoç3, Firdovsi Ibrahimov1, Hakan Kültürsay2
1Department of Cardiology, Central Clinic Hospital, Baku, Azerbaijan
2Department of Cardiology, Ege University School of Medicine, İzmir, Türkiye
3Department of Pulmonology, Ege University School of Medicine, İzmir, Türkiye


OBJECTIVE
Heart rate variability (HRV), which is defined as cyclic changes in sinus rate with time, is used as a measure of cardiac autonomic tone. Our aim was to determine the impact of HRV on short-term prognosis in pulmonary hypertension (PH).


METHODS
We enrolled 64 PH patients and 69 healthy subjects (control group). Patients were evaluated by Holter-ECG, echocardiography, and laboratory tests. 24-h Holter-ECG monitoring was used for HRV. The development of adverse events (right heart failure, hospitalization, syncope, and death) during the 6-month follow-up was evaluated in PH group.


RESULTS
PH group (39 ± 16 years, 37.5% males) comprised of 16 patients with idiopathic pulmonary arterial hypertension (PAH) (25%), 36 patients with PAH associated with congenital heart disease (56.3%), 3 PAH associated with connective tissue disease (4.7%), 1 with portopulmonary (1.6%), and 8 chronic thromboembolic PH (12.5%). The time-dependent (standard deviation of all NN intervals for a selected time period [SDNN], standard deviation of the 5-min mean R–R intervals tabulated over an entire day [SDANN], SDNN Index, and Triangular Index) and frequency-dependent HRV indices (low frequency, high-frequency power, and total power,) were significantly reduced in those with PH. Functional class was negatively associated with SDNN, SDANN, SDNN Index, and Triangular Index. Adverse events developed in 25% of the patients during the 6-month follow-up period (200 ± 92 days) (7 patients had right-heart failure, 5 syncope, 12 patients were hospitalized, and 9 had died). All the time and frequency-dependent indices significantly associated with adverse events. Mortality correlated with SDNN (rS = −0.354, P = 0.005), SDANN (rS = −0.368, P = 0.004), SDNN Index (rS = −0.257, P = 0.045), Triangular Index (rS = −0.310, P = 0.014), and VLF (rS = −0.265, P = 0.039).


CONCLUSION
HRV is significantly depressed in patients with PH and is associated with the clinical status. HRV indices might predict clinical deterioration, adverse events, and mortality for 6 months. Non-invasive assessment of HRV through Holter-ECG may be a valuable and practical tool in risk stratification of patients with PH for short-term outcomes.

Keywords: Adverse events, heart rate variability, Holter ECG, mortality, prognosis, pulmonary hypertension

How to cite this article
Ogtay Musayev, Meral Kayıkçıoğlu, Shafa Shahbazova, Sanem Nalbantgil, Nesrin Moğulkoç, Firdovsi Ibrahimov, Hakan Kültürsay. Could Heart Rate Variability Serve as a Prognostic Factor in Patients with Pulmonary Hypertension? A Single-center Pilot Study. Turk Kardiyol Dern Ars. 2023; 51(7): 454-463

Corresponding Author: Ogtay Musayev
Manuscript Language: English


Journal Metrics

Journal Citation Indicator: 0.18
CiteScore: 1.1
Source Normalized Impact
per Paper:
0.22
SCImago Journal Rank: 0.348

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