Association Between 24-hour Holter Monitoring Parameters And The Improvement Of Left Ventricular Ejection Fraction In Heart Failure With Reduced Ejection Fraction

Objective Compared with heart failure with reduced ejection fraction(HFr EF),heart failure with improved ejection fraction(HFimp EF)has a better prognosis.The purpose of this study was to evaluate the association of 24-hour holter monitoring parameters including arrhythmias and heart rate variability with left ventricular ejection fraction(LVEF)improvement in patients with HFr EF.Methods 1344 HFr EF patients who were firstly hospitalized for heart failure in the affiliated Anhui provincial hospital of Anhui medical university were enrolled from November 2018 to November 2021.286 HFr EF patients with 24-hour holter monitoring at baseline and echocardiography followed up within 1 year were analysed.210 HFr EF patients with sinus rhythm were analysed for heart rate variability.Using baseline and serial echocardiogram,patients were classified into two subgroups: HFimp EF group and the control group.The difference between two groups in baseline clinical data,echocardiographic and holter monitoring parameters were analysed.Predictors of LVEF improvement were analyzed by the logistic regression.Results 132 patients(46.2%)met the criteria of HFimp EF group,and the other 154 patients served as control group.HFimp EF patients were usually female,with smaller left atrial diameter(LAD)and left ventricular end-diastolic diameter(LVEDD)at baseline,fewer premature ventricular contractions,and higher the standard deviation of all NN intervals(SDNN),the mean of the standard deviations of all normal sinus NN intervals for all 5-min segments(SDNN Index)and low frequency(LF)(all P<0.05).In a multivariate logistic regression model:1)the arrhythmias were not independent factors of the improvement of LVEF;2)in patients with sinus rhythm: higher SDNN Index(OR:1.026,95% CI:1.008-1.044,P=0.004)was independently associated with the improvement of LVEF.Conclusion The arrhythmias were not independently associated with the improvement of LVEF.In HFr EF patients with sinus rhythm,SDNN Index is an independent predicttor of LVEF improvement.