• Iwona Cygankiewicz, Wojciech Zareba, Rafael Vazquez, Montserrat Vallverdu, Jose R Gonzalez-Juanatey, Mariano Valdes, Jesus Almendral, Juan Cinca, Pere Caminal, Antoni Bayes de Luna, and Muerte Subita en Insuficiencia Cardiaca Investigators.
• Catalan Institute of Cardiovascular Sciences, Barcelona, Spain; University of Rochester, Rochester, New York 14642, USA. iwona.cygankiewicz@heart.rochester.edu
• Heart Rhythm. 2008 Aug 1; 5 (8): 1095-1102.

BackgroundAbnormal heart rate turbulence (HRT) has been documented as a strong predictor of total mortality and sudden death in postinfarction patients, but data in patients with congestive heart failure (CHF) are limited.ObjectiveThe aim of this study was to evaluate the prognostic significance of HRT for predicting mortality in CHF patients in New York Heart Association (NYHA) class II-III.MethodsIn 651 CHF patients with sinus rhythm enrolled into the MUSIC (Muerte Subita en Insuficiencia Cardiaca) study, the standard HRT parameters turbulence onset (TO) and slope (TS), as well as HRT categories, were assessed for predicting total mortality and sudden death.ResultsHRT was analyzable in 607 patients, mean age 63 years (434 male), 50% of ischemic etiology. During a median follow up of 44 months, 129 patients died, 52 from sudden death. Abnormal TS and HRT category 2 (HRT2) were independently associated with increased all-cause mortality (HR: 2.10, CI: 1.41 to 3.12, P <.001 and HR: 2.52, CI: 1.56 to 4.05, P <.001; respectively), sudden death (HR: 2.25, CI: 1.13 to 4.46, P = .021 for HRT2), and death due to heart failure progression (HR: 4.11, CI: 1.84 to 9.19, P <.001 for HRT2) after adjustment for clinical covariates in multivariate analysis. The prognostic value of TS for predicting total mortality was similar in various groups dichotomized by age, gender, NYHA class, left ventricular ejection fraction, and CHF etiology. TS was found to be predictive for total mortality only in patients with QRS > 120 ms.ConclusionHRT is a potent risk predictor for both heart failure and arrhythmic death in patients with class II and III CHF.

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