Assessing the interaction of respiration and heart rate in heart failure and controls using ambulatory Holter recordings

Mark Haigney*, Wojceich Zareba, Maria Teresa La Rovere, Ian Grasso, David Mortara

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Breathing is a critical component of cardiopulmonary function, but few tools exist to evaluate respiration in ambulatory patients. Holter monitoring allows accurate diagnosis of a host of cardiac issues, and several investigators have demonstrated the ability to detect respiratory effort on the electrocardiogram. In this study we introduce a myogram signal derived from 12-lead, high frequency Holter as a means of detecting respiratory effort. Using the combined myogram and ECG signal, four novel variables were created: total number of Cheyne-Stokes episodes; the BWRatio, the ratio of power (above baseline) measured one second after peak-to-peak respiratory power, an assessment of the "shape" of the respiratory effort; DRR, the change in RR interval centering around peak inspiration; and minutes of synchronized breathing, a fixed ratio of heart beats to respiratory cycles. These variables were assessed in 24-hour recordings from three cohorts: healthy volunteers (n = 33), heart failure subjects from the GISSI HF trial (n = 383), and subjects receiving implantable defibrillators with severely depressed left ventricular function enrolled in the M2Risk trial (n = 470). We observed a statistically significant 6-fold increase in the number of Cheyne-Stokes episodes (p = 0.01 by ANOVA), decreases in BWRatio (p < 0.001), as well as decrease in DRR in heart failure subjects; only minutes of synchronized breathing was not significantly decreased in heart failure. This study provides "proof of concept" that novel variables incorporating Holter-derived respiration can distinguish healthy subjects from heart failure. The utility of these variables for predicting heart failure, arrhythmia, and death risk in prospective studies needs to be assessed.

Original languageEnglish
Pages (from-to)831-835
Number of pages5
JournalJournal of Electrocardiology
Issue number6
StatePublished - 1 Nov 2014
Externally publishedYes


  • Cheyne-Stokes
  • Heart failure
  • Holter
  • Respiration
  • Sleep apnea


Dive into the research topics of 'Assessing the interaction of respiration and heart rate in heart failure and controls using ambulatory Holter recordings'. Together they form a unique fingerprint.

Cite this