Short-Term Heart Rate Variability Dynamics and Mortality Risk After Acute Coronary Syndrome

TL;DR

This study shows that changes in heart rate variability after a heart attack can predict mortality risk, offering a practical tool for assessing patient outcomes.

Contribution

The study identifies specific short-term HRV dynamics as novel predictors of mortality after acute coronary syndrome.

Findings

Patients who died had lower HRV values and significant declines in specific HRV parameters on day 21.

Decreased ΔLF and shorter RR intervals independently predicted overall mortality in multivariable analysis.

Unfavorable HRV changes may indicate persistent autonomic imbalance and could improve prognostic assessment.

Abstract

Background/Objectives: Heart rate variability (HRV) is a non-invasive marker of autonomic nervous system function with established prognostic value after acute coronary syndrome (ACS). The clinical relevance of temporal changes in short-term HRV remains insufficiently defined. This study evaluated short-term HRV dynamics and their association with mortality after ACS. Methods: This retrospective–prospective study included 230 patients with acute myocardial infarction. Five-minute resting ECG recordings were obtained on day 1 and day 21. Time- and frequency-domain HRV parameters were analyzed, and delta values were calculated. The primary endpoint was overall mortality. Survival was assessed using Kaplan–Meier analysis and Cox regression. Results: Patients who died during follow-up had lower HRV values on day 21 and more pronounced declines in selected parameters. In multivariable analysis, decreased ΔLF and shorter RR intervals independently predicted overall mortality. Conclusions: Short-term HRV provides a practical bedside assessment of autonomic function after ACS. Unfavorable temporal changes likely reflect persistent autonomic imbalance and may offer additional prognostic insight. Larger contemporary studies are needed to confirm these findings.

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