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(Circulation. 2000;101:47.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Fractal Correlation Properties of R-R Interval Dynamics and Mortality in Patients With Depressed Left Ventricular Function After an Acute Myocardial Infarction
From the Division of Cardiology, Department of Medicine, University of Oulu, Finland (H.V.H.); Department of Cardiology, Odense University Hospital, Odense, Denmark (T.H.M., U.H., M.M.); and The Margret and H.A. Rey Laboratory for Nonlinear Dynamics in Medicine and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (C.-K.P., A.L.G.).
Correspondence to Heikki V. Huikuri, MD, Division of Cardiology, Department of Medicine, University of Oulu, Kajaanintie 50, 90220 Oulu, Finland. E-mail heikki.huikuri{at}oulu.fi
Background—Preliminary data suggest that the analysis of R-R interval variability by fractal analysis methods may provide clinically useful information on patients with heart failure. The purpose of this study was to compare the prognostic power of new fractal and traditional measures of R-R interval variability as predictors of death after acute myocardial infarction.
Methods and Results—Time and frequency domain heart rate (HR)
variability measures, along with short- and long-term correlation
(fractal) properties of R-R intervals (exponents 
1 and
2) and power-law scaling of the power spectra (exponent
ß), were assessed from 24-hour Holter recordings in 446
survivors of acute myocardial infarction with a depressed left
ventricular function (ejection fraction 
35%). During a
mean±SD follow-up period of 685±360 days, 114 patients died (25.6%),
with 75 deaths classified as arrhythmic (17.0%) and 28 as
nonarrhythmic (6.3%) cardiac deaths. Several traditional and fractal
measures of R-R interval variability were significant
univariate predictors of all-cause mortality. Reduced
short-term scaling exponent 1 was the most powerful R-R
interval variability measure as a predictor of all-cause mortality
(1 <0.75, relative risk 3.0, 95% confidence interval
2.5 to 4.2, P<0.001). It remained an independent
predictor of death (P<0.001) after adjustment for other
postinfarction risk markers, such as age, ejection fraction, NYHA
class, and medication. Reduced 1 predicted both
arrhythmic death (P<0.001) and nonarrhythmic cardiac
death (P<0.001).
Conclusions—Analysis of the fractal characteristics of short-term R-R interval dynamics yields more powerful prognostic information than the traditional measures of HR variability among patients with depressed left ventricular function after an acute myocardial infarction.
Key Words: mortality • heart rate • infarction
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