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European Journal of Heart Failure 2002 4(2):151-158; doi:10.1016/S1388-9842(01)00227-6
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© 2002 European Society of Cardiology

Fractal correlation properties of R-R interval dynamics in asymptomatic relatives of patients with dilated cardiomyopathy{star}

Niall G. Mahona,*, Antti E. Hedmanb, Mina Padulaa, Yi Ganga, Irina Savelievaa, Johan E.P. Waktarea, Marek M. Malika, Heikki V. Huikuric and William J. McKennaa

a Department of Cardiological Sciences St George's Hospital Medical School, London, UK
b Division of Cardiology Kuopio University Hospital, Kuopio, Finland
c Division of Cardiology, Department of Medicine University of Oulu, Oulu, Finland

* Corresponding author. Department of Cardiology/Section of Heart Failure and Transplantation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA; tel.: +1-216-444-2268; fax: +1-216-444-7155. E-mail address: mahonn{at}ccf.org


  Abstract

Background and aim: asymptomatic relatives of patients with familial dilated cardiomyopathy who have left ventricular enlargement [LVE] are at risk for progression to dilated cardiomyopathy. A novel index of the fractal correlation properties of heart rate variability (HRV), the short-term scaling component ({propto}1) in detrended fluctuation analysis, is a promising prognostic tool in left ventricular dysfunction. The aim of this study was to compare values of {propto}1 and conventional HRV indices in LVE relatives with dilated cardiomyopathy patients and normal controls.

Methods: time-domain and spectral HRV measures, and the short-term scaling component ({propto}1) were assessed from 24-h Holter recordings from 22 LVE relatives (left ventricular end-diastolic dimension >112% predicted, normal fractional shortening), 24 dilated cardiomyopathy patients and 14 controls.

Results: the time domain index SDNN was lower in dilated cardiomyopathy patients [101.8(±44.0)] than in LVE relatives [161.7(±53.9)] or controls [152.9(±51.4)], P = 0.01. Similarly, triangular index and spectral measures were reduced in dilated cardiomyopathy patients but not in LVE relatives or controls. In contrast, the short term scaling component ({propto}1) in detrended fluctuation analysis was reduced in both dilated cardiomyopathy patients [1.06(±0.33)] and in LVE relatives [1.15 (±0.20)], compared with controls [1.32(±0.16)], P = 0.01. Among DCM patients the short-term scaling component ({propto}1) was significantly associated with echocardiographic deterioration during follow-up (3.7±2.1 year) (P = 0.004).

Conclusion: the short-term scaling component ({propto}1) is reduced in asymptomatic relatives of dilated cardiomyopathy patients who have LVE.

Key Words: Dilated cardiomyopathy • Heart rate variability

Received May 18, 2001; Revised August 1, 2001; Accepted October 23, 2001

{star} Presented in part at the American Heart Association Scientific Sessions, November 2000, New Orleans, Louisiana, USA.


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