Open Access Highly Accessed Research article

Prognostic significance of heart rate turbulence parameters in patients with chronic heart failure

De-Chun Yin1, Zhao-Jun Wang1, Shuai Guo1, Hong-Yu Xie1, Lin Sun1, Wei Feng1, Wei Qiu1 and Xiu-Fen Qu12*

Author Affiliations

1 Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P.R. China

2 Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Dazhi Street No.199, Nangang District, Harbin 150001, P.R. China

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BMC Cardiovascular Disorders 2014, 14:50  doi:10.1186/1471-2261-14-50

Published: 13 April 2014



This study is aimed to evaluate the clinical significance of heart rate turbulence (HRT) parameters in predicting the prognosis in patients with chronic heart failure (CHF).


From June 2011 to December 2012, a total of 104 CHF patients and 30 healthy controls were enrolled in this study. We obtained a 24-hour Holter ECG recording to assess the HRT parameters, included turbulence onset (TO), turbulence slope (TS), standard deviation of N-N intervals (SDNN), and resting heart rate (RHR). The relationships between HRT parameters and the prognosis of CHF patients were determined.


The assessment follow-up period lasted until January 31, 2013. The overall mortality of CHF patients was 9.6% (10/104). Our results revealed that CHF patients had higher levels of TO than those of healthy subjects, but the TS levels of CHF patients were lower than that of the control group. CHF patients with NYHA grade IV had higher HRT1/2 rate than those with NYHA grade II/III. There were statistical differences in TS, LVEF, SDNN and RHR between the non-deteriorating group and the non-survivor group. Significant differences in TS among the three groups were also found. Furthermore, CHF patients in the non-survivor group had lower levels of TS than those in the deteriorating group. Correlation analyses indicated that TO negatively correlate with SDNN, while TS positively correlated with SDNN and left ventricular ejection fraction (LVEF). We also observed negative correlations between TS and left ventricular end-diastolic cavity dimension (LVEDD), RHR, homocysteine (Hcy) and C-reactive protein (CRP). Multivariate Cox regression analysis further confirmed that LVEF (≤30%), HRT2, SDNN and RHR were independent risk factors which can indicate poor prognosis in CHF patients.


Our findings indicate that HRT may have good clinical predictive value in patients with CHF. Thus, quantifying HRT parameters could be a useful tool for predicting mortality in CHF patients.

Heart rate turbulence; Chronic heart failure; Prognosis