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Cited by 1,712Heart Rate Variability and Autonomic ControlCardiac Health and Mental HealthAcute Myocardial Infarction Research

Frequency domain measures of heart period variability and mortality after myocardial infarction

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Bigger, J T, Fleiss, J L, Steinman, R C, Rolnitzky, L M, Kleiger, R E, Rottman, J N·1992·Circulation
DOI 10.1161/01.cir.85.1.164
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Abstract

BACKGROUND: We studied 715 patients 2 weeks after myocardial infarction to establish the associations between six frequency domain measures of heart period variability (HPV) and mortality during 4 years of follow-up. METHODS AND RESULTS: Each measure of HPV had a significant and at least moderately strong univariate association with all-cause mortality, cardiac death, and arrhythmic death. Power in the lower-frequency bands--ultra low frequency (ULF) and very low frequency (VLF) power--had stronger associations with all three mortality end points than power in the higher-frequency bands--low frequency (LF) and high frequency (HF) power. The 24-hour total power also had a significant and strong association with all three mortality end points. VLF power was the only variable that was more strongly associated with arrhythmic death than with cardiac death or all-cause mortality. In multivariate Cox regression models using a step-up approach to evaluate the independent associations between frequency domain measures of heart period variability and death of all causes, ULF power was selected first (i.e., was the single component with the strongest association). Adding VLF or LF power to the Cox regression model significantly improved the prediction of outcome. With both ULF and VLF power in the Cox regression model, the addition of the other two components, LF and HF power, singly or together, did not significantly improve the prediction of all-cause mortality. We explored the relation between the heart period variability measures and all-cause mortality, cardiac death, and arrhythmic death before and after adjusting for five previously established postinfarction risk predictors: age, New York Heart Association functional class, rales in the coronary care unit, left ventricular ejection fraction, and ventricular arrhythmias detected in a 24-hour Holter ECG recording. CONCLUSIONS: After adjustment for the five risk predictors, the association between mortality and total, ULF, and VLF power remained significant and strong, whereas LF and HF power were only moderately strongly associated with mortality. The tendency for VLF power to be more strongly associated with arrhythmic death than with all-cause or cardiac death was still evident after adjusting for the five covariates. Adding measures of HPV to previously known predictors of risk after myocardial infarction identifies small subgroups with a 2.5-year mortality risk of approximately 50%.

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Crossref · 10.1161/01.cir.85.1.164

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  • Altered sympathovagal balance characterized by decreased heart rate variability has been recognized in people and dogs with various disorders.

    “Altered sympathovagal balance characterized by decreased HRV has been recognized in people and dogs with various disorders (Bigger et al 1992, Fauchier et al 1999, Calvert and Wall 2001).”

    From Heart rate and heart rate variability of healthy cats in home and hospital environments (2005) · cites this paper as Bigger et al 1992

    The Time Series Analysis of Normal RR Intervals section identifies the LF-to-HF ratio as an indicator of sympathovagal balance, and the paper reports reduced heart-period variability as a risk predictor in people after myocardial infarction. It does not establish decreased HRV in dogs or across the various disorders claimed; dogs appear in cited references rather than in this paper's findings. Page numbers were not available in our copy. (LLM, conf=0.84)

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  • Decreased HRV values have been consistently reported in post-MI infarction and heart failure patients.

    “Decreased HRV values have been consistently reported in post-MI infarction and heart failure patients (Bigger et al., 1992;Kleiger et al., 1987;La Rovere et al., 2003, 2012;Makikallio et al., 2005).”

    From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Bigger et al., 1992

    The Abstract reports that heart-period variability measures predict mortality after myocardial infarction, supporting an association between low variability and risk in post-MI patients. It does not establish that HRV is generally decreased in all post-MI patients. The Time Series Analysis of Normal RR Intervals section mentions a relative increase in one frequency component in congestive heart failure, not a general decrease in HRV among heart-failure patients. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Reduced heart rate variability is prognostically important in people who have suffered myocardial infarction and in those with heart failure.

    “The finding of reduced heart rate variability is prognostically important in people who have suffered myocardial infarction and in those with heart failure (Bigger et al 1992, Nolan et al 1998).”

    From Heart rate and heart rate variability of healthy cats in home and hospital environments (2005) · cites this paper as Bigger et al 1992

  • Quantification of heart rate variability has been used to characterize sympathovagal balance and to assess autonomic function.

    “Quantification of heart rate variability (HRV) has been used to characterize sympathovagal balance and in so doing, assess autonomic function (Bigger et al 1992, Nolan et al 1998, Fauchier et al 1999, Calvert and Wall 2001, Spier and Meurs 2004).”

    From Heart rate and heart rate variability of healthy cats in home and hospital environments (2005) · cites this paper as Bigger et al 1992

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Cites

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Research works printed but not linked: 10

  1. [1]1. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ, the Multicenter Post-Infarction Research Group: Decreased heart rate vari- ability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987;59:256-262
  2. [2]2. Myers GA, Martin GJ, Magid NM, Barnett PS, Schaad JW, Weiss JS, Lesch M, Singer DH: Power spectral analysis of heart rate variability in sudden cardiac death: Comparison to other methods. IEEE Trans Biomed Eng 1986;BME-33: 1149-1156
  3. [3]3. Lombardi F, Sandrone G, Pernpruner S, Sala R, Garimoldi M, Cerutti S, Baselli G, Pagani M, Malliani A: Heart rate variability as an index of sympatho-vagal interaction in patients after myocardial infarction. Am J Cardiol 1987;60: 1239-1245
  4. [7]7. The Multicenter Post-Infarction Research Group: Risk strat- ification and survival after myocardial infarction. N Engi J Med 1983;309:331-336
  5. [8]8. Bigger JT Jr, Fleiss JL, Kleiger RE, Miller JP, Rolnitzky LM, the Multicenter Post-Infarction Research Group: The rela- tionships among ventricular arrhythmias, left ventricular dys- function and mortality in the 2 years after myocardial infarc- tion. Circulation 1984;69:250-258
  6. [12]12. Koizumi K, Terui N, Kollai M: Effect of cardiac vagal and sympathetic nerve activity on heart rate in rhythmic regula- tions. J Auton Nerv Syst 1985;12:251-259
  7. [13]13. Katona PG, Jih F: Respiratory sinus arrhythmia: Measure of the parasympathetic cardiac control. J Appi Physiol 1975;39: 801-805
  8. [17]17. Cox DR: Regression models and life tables (with discussion). JR Stat Soc B 1972;34:187-220
  9. [19]19. Bigger JT Jr, Fleiss JL, Rolnitzky LM, The Multicenter Post-Infarction Research Group: Prevalence, characteristics, and significance of ventricular tachycardia detected by 24-hour continuous electrocardiographic recordings in the late hospital phase of acute myocardial infarction. Am J Cardiol 1986;58:1151-1160
  10. [26]26. Bigger JT Jr, Steinberg JS: Risk stratification for arrhythmic death after myocardial infarction: An overview, in El-Sherif N, Samet P (eds): Cardiac Pacing and Electrophysiology. Philadel- phia, WB Saunders, 1990, pp 303-322

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Authors
Bigger, J. T., Fleiss, J. L., Steinman, R. C., Rolnitzky, L. M., Kleiger, R. E., & Rottman, J. N.
Affiliations
Columbia University (US)
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1992-01
Volume
85
Issue
1
Pages
164-171
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.85.1.164
OpenAlex
W2076386730
Cited by
1,712
References
16
Citations by year
2026: 8 · 2025: 23 · 2024: 28 · 2023: 24 · 2022: 37 · 2021: 41 · 2020: 41 · 2019: 34 · 2018: 37 · 2017: 54 · 2016: 45 · 2015: 48 · 2014: 42 · 2013: 63 · 2012: 56
FWCI
34.91
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01hl041552-04, RR-00645)
  • National Heart, Lung, and Blood Institute (HL-41552, HL-70204, RR-00645)
  • National Center for Research Resources (RR 00645, M01RR000645)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
heart rate variability, frequency domain analysis, myocardial infarction, very low frequency power, arrhythmic death, cardiovascular mortality, all-cause mortality, autonomic nervous system, risk prediction, Holter monitoring
MeSH terms
Aged, Forecasting, Heart Rate, Humans, Myocardial Infarction, Risk Factors, Multivariate Analysis, Survival Analysis

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