{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:41:04Z","timestamp":1785213664246,"version":"3.55.0"},"reference-count":92,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objective: In the landscape of heart failure, non-cardiac comorbidities represent a formidable challenge, imparting adverse prognostic implications. Holter ECG monitoring assumes a supplementary role in delineating myocardial susceptibility and autonomic nervous system dynamics. This study aims to explore the potential correlation between Holter ECG parameters and comorbidities in individuals with ischemic cardiomyopathy experiencing heart failure (HF), with a particular focus on the primary utility of these parameters as prognostic indicators. Materials and Methods: In this prospective inquiry, a cohort of 60 individuals diagnosed with heart failure underwent stratification into subgroups based on the presence of comorbidities, including diabetes, chronic kidney disease, obesity, or hyperuricemia. Upon admission, a thorough evaluation of all participants encompassed echocardiography, laboratory panel analysis, and 24 h Holter monitoring. Results: Significant associations were uncovered between diabetes and unconventional physiological indicators, specifically the Triangular index (p = 0.035) and deceleration capacity (p = 0.002). Pertaining to creatinine clearance, notable correlations surfaced with RMSSD (p = 0.026), PNN50 (p = 0.013), and high-frequency power (p = 0.026). An examination of uric acid levels and distinctive Holter ECG patterns unveiled statistical significance, particularly regarding the deceleration capacity (p = 0.045). Nevertheless, in the evaluation of the Body Mass Index, no statistically significant findings emerged concerning Holter ECG parameters. Conclusions: The identified statistical correlations between non-cardiac comorbidities and patterns elucidated in Holter ECG recordings underscore the heightened diagnostic utility of this investigative modality in the comprehensive evaluation of individuals grappling with HF. Furthermore, we underscore the critical importance of the thorough analysis of Holter ECG recordings, particularly with regard to subtle and emerging parameters that may be overlooked or insufficiently acknowledged.<\/jats:p>","DOI":"10.3390\/medicina60020342","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T11:23:57Z","timestamp":1708341837000},"page":"342","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Harmony in Chaos: Deciphering the Influence of Ischemic Cardiomyopathy and Non-Cardiac Comorbidities on Holter ECG Parameters in Chronic Heart Failure Patients: A Pilot Study"],"prefix":"10.3390","volume":"60","author":[{"given":"\u0218tefania-Teodora","family":"Duca","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of Cardiology, \u201cSt. Spiridon\u201d Emergency County Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8942-1909","authenticated-orcid":false,"given":"Minerva Codruta","family":"Badescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of III Internal Medicine Clinic, \u201cSt. Spiridon\u201d Emergency County Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8544-9904","authenticated-orcid":false,"given":"Alexandru-Dan","family":"Costache","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Chetran","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of Cardiology, \u201cSt. Spiridon\u201d Emergency County Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2610-6482","authenticated-orcid":false,"given":"Radu \u0218tefan","family":"Miftode","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of Cardiology, \u201cSt. Spiridon\u201d Emergency County Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4956-2595","authenticated-orcid":false,"given":"Ionu\u021b","family":"Tudorancea","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cSt. Spiridon\u201d Emergency County Hospital, 700111 Iasi, Romania"},{"name":"Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9438-8565","authenticated-orcid":false,"given":"Ovidiu","family":"Mitu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of Cardiology, \u201cSt. Spiridon\u201d Emergency County Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Afr\u0103s\u00e2nie","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of Cardiology, \u201cSt. Spiridon\u201d Emergency County Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1234-6933","authenticated-orcid":false,"given":"Radu-George","family":"Ciorap","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Faculty of Medical Bioengineering, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700145 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ionela-L\u0103cr\u0103mioara","family":"\u0218erban","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5719-7591","authenticated-orcid":false,"given":"D. Robert","family":"Pav\u0103l","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Dmour","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria-Ruxandra","family":"Cepoi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina-Iuliana","family":"Costache-Enache","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy \u201cGrigore T. Popa\u201d, 700115 Iasi, Romania"},{"name":"Department of Cardiology, \u201cSt. Spiridon\u201d Emergency County Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/ejhf.2333","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"24","author":"McDonagh","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1002\/ejhf.1858","article-title":"Epidemiology of heart failure","volume":"22","author":"Groenewegen","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"650278","DOI":"10.3389\/fcvm.2021.650278","article-title":"Metabolism and Chronic Inflammation: The Links Between Chronic Heart Failure and Comorbidities","volume":"8","author":"Li","year":"2021","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: A comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e006541","DOI":"10.1161\/CIRCHEARTFAILURE.119.006541","article-title":"Comparison of BNP and NT-proBNP in Patients With Heart Failure and Reduced Ejection Fraction","volume":"13","author":"Jhund","year":"2020","journal-title":"Circ. Heart Fail."},{"key":"ref_6","first-page":"6305","article-title":"Clinical significance of sFRP5, RBP-4, and NT-proBNP in patients with chronic heart failure","volume":"13","author":"An","year":"2021","journal-title":"Am. J. Transl. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1002\/ehf2.13906","article-title":"NT-ProBNP and high-sensitivity troponin T as screening tests for subclinical chronic heart failure in a general population","volume":"9","author":"Averina","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1002\/cpt.2222","article-title":"NT-proBNP Qualifies as a Surrogate for Clinical End Points in Heart Failure","volume":"110","author":"Schmitt","year":"2021","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1002\/clc.23850","article-title":"Prognostic value of RDW alone and in combination with NT-proBNP in patients with heart failure","volume":"45","author":"Liang","year":"2022","journal-title":"Clin. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"684919","DOI":"10.3389\/fcvm.2021.684919","article-title":"Predictive Value of the Serum Cystatin C\/Prealbumin Ratio in Combination With NT-proBNP Levels for Long-Term Prognosis in Chronic Heart Failure Patients: A Retrospective Cohort Study","volume":"8","author":"Wang","year":"2021","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Pan, W., Yang, D., Yu, P., and Yu, H. (2020). Comparison of predictive value of NT-proBNP, sST2, and MMPs in heart failure patients with different ejection fractions. BMC Cardiovasc. Disord., 20.","DOI":"10.1186\/s12872-020-01493-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jjcc.2019.07.012","article-title":"Risk stratification for cardiac mortality using electrocardiographic markers based on 24-h Holter recordings: The JANIES-SHD study","volume":"75","author":"Kinoshita","year":"2020","journal-title":"J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1080\/14779072.2020.1732208","article-title":"Machine learning for predicting cardiac events: What does the future hold?","volume":"18","author":"Patel","year":"2020","journal-title":"Expert. Rev. Cardiovasc. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.jelectrocard.2023.08.018","article-title":"Recent progress of Holter-based late potential for predicting serious cardiac events and its implications and future challenges","volume":"81","author":"Hashimoto","year":"2023","journal-title":"J. Electrocardiol."},{"key":"ref_15","first-page":"128","article-title":"Usefulness of continuous 24-h ventricular late potential to predict prognosis in patients with heart failure","volume":"39","author":"Matsuzaki","year":"2014","journal-title":"Tokai J. Exp. Clin. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e12803","DOI":"10.1111\/anec.12803","article-title":"Combined evaluation of ambulatory-based late potentials and nonsustained ventricular tachycardia to predict arrhythmic events in patients with previous myocardial infarction: A Japanese noninvasive electrocardiographic risk stratification of sudden cardiac death (JANIES) substudy","volume":"26","author":"Hashimoto","year":"2021","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_17","first-page":"241","article-title":"Time domain analysis of the signal-averaged electrocardiogram to detect late potentials in heart failure patients with different etiologies","volume":"87","author":"Tobias","year":"2006","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jelectrocard.2008.03.001","article-title":"Ventricular late potentials: A critical overview and current applications","volume":"41","author":"Santangeli","year":"2008","journal-title":"J. Electrocardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jelectrocard.2018.11.006","article-title":"The role of heart rate variability, heart rate turbulence, and deceleration capacity in predicting cause-specific mortality in chronic heart failure","volume":"52","author":"Pietrasik","year":"2019","journal-title":"J. Electrocardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/j.1540-8159.2006.00457.x","article-title":"The role of heart rate variability in prognosis for different modes of death in chronic heart failure","volume":"29","author":"Sandercock","year":"2006","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/1099800419877442","article-title":"Heart Rate Variability and Risk of All-Cause Death and Cardiovascular Events in Patients With Cardiovascular Disease: A Meta-Analysis of Cohort Studies","volume":"22","author":"Fang","year":"2020","journal-title":"Biol. Res. Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3389\/fpubh.2017.00258","article-title":"An Overview of Heart Rate Variability Metrics and Norms","volume":"5","author":"Shaffer","year":"2017","journal-title":"Front. Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.ijcard.2009.09.543","article-title":"The relationship of autonomic imbalance, heart rate variability, and cardiovascular disease risk factors","volume":"141","author":"Thayer","year":"2010","journal-title":"Int. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Yin, D.C., Wang, Z.J., Guo, S., Xie, H.Y., Sun, L., Feng, W., Qiu, W., and Qu, X.F. (2014). Prognostic significance of heart rate turbulence parameters in patients with chronic heart failure. BMC Cardiovasc. Disord., 14.","DOI":"10.1186\/1471-2261-14-50"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zeid, S., Buch, G., Velmeden, D., S\u00f6hne, J., Schulz, A., Schuch, A., Tr\u00f6bs, S.O., Heidorn, M.W., M\u00fcller, F., and Strauch, K. (2023). Heart rate variability: Reference values and role for clinical profile and mortality in individuals with heart failure. Clin. Res. Cardiol.","DOI":"10.1007\/s00392-023-02248-7"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"23617","DOI":"10.1038\/srep23617","article-title":"Deceleration and acceleration capacities of heart rate associated with heart failure with high discriminating performance","volume":"6","author":"Hu","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.jelectrocard.2012.01.002","article-title":"Exercise training slows down heart rate and improves deceleration and acceleration capacity in patients with heart failure","volume":"45","author":"Migliaro","year":"2012","journal-title":"J. Electrocardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/eci.12594","article-title":"Heart acceleration and deceleration capacities associated with dilated cardiomyopathy","volume":"46","author":"Zou","year":"2016","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.ijcard.2016.06.205","article-title":"Deceleration capacity: A novel predictor for total mortality in patients with non-ischemic dilated cardiomyopathy","volume":"221","author":"Demming","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"614946","DOI":"10.3389\/fphys.2021.614946","article-title":"Electrophysiological Mechanisms Underlying T-Wave Alternans and Their Role in Arrhythmogenesis","volume":"12","author":"You","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1161\/CIRCULATIONAHA.107.748962","article-title":"Role of Microvolt T-Wave Alternans in Assessment of Arrhythmia Vulnerability Among Patients With Heart Failure and Systolic Dysfunction\u2014Primary Results From the T-Wave Alternans Sudden Cardiac Death in Heart Failure Trial Substudy","volume":"118","author":"Gold","year":"2008","journal-title":"Circulation"},{"key":"ref_32","first-page":"9","article-title":"Comparison of T Wave Alternans in Patients With Ischemic and Non-Ischemic Cardiomyopathy","volume":"18","author":"Ashraf","year":"2022","journal-title":"Pak. J. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2984","DOI":"10.1161\/CIRCULATIONAHA.107.699918","article-title":"Is microvolt T-wave alternans the answer to risk stratification in heart failure?","volume":"116","author":"Myles","year":"2007","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.hrthm.2011.10.027","article-title":"Average T-wave alternans activity in ambulatory ECG records predicts sudden cardiac death in patients with chronic heart failure","volume":"9","author":"Monasterio","year":"2012","journal-title":"Heart Rhythm."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.1016\/j.jacc.2007.09.004","article-title":"Prognostic value of T-wave alternans in patients with heart failure due to nonischemic cardiomyopathy: Results of the ALPHA Study","volume":"50","author":"Klersy","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s10741-020-09987-z","article-title":"Pathogenesis of chronic heart failure: Cardiovascular aging, risk factors, comorbidities, and disease modifiers","volume":"27","author":"Triposkiadis","year":"2022","journal-title":"Heart Fail. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ejim.2019.10.008","article-title":"Comorbidities in chronic heart failure: An update from Italian Society of Cardiology (SIC) Working Group on Heart Failure","volume":"71","author":"Correale","year":"2020","journal-title":"Eur. J. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1002\/ejhf.1818","article-title":"Trends in prevalence of comorbidities in heart failure clinical trials","volume":"22","author":"Khan","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1136\/hrt.2005.068296","article-title":"Non-cardiac comorbidities in chronic heart failure","volume":"93","author":"Lang","year":"2007","journal-title":"Heart"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s11897-012-0110-z","article-title":"Prevalence and importance of comorbidities in patients with heart failure","volume":"9","author":"Triposkiadis","year":"2012","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1161\/01.CIR.83.4.1481","article-title":"Standards for analysis of ventricular late potentials using high-resolution or signal-averaged electrocardiography. A statement by a Task Force Committee of the European Society of Cardiology, the American Heart Association, and the American College of Cardiology","volume":"83","author":"Breithardt","year":"1991","journal-title":"Circulation"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jelectrocard.2011.08.006","article-title":"Heart rate deceleration runs for postinfarction risk prediction","volume":"45","author":"Guzik","year":"2012","journal-title":"J. Electrocardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"118","DOI":"10.2459\/JCM.0b013e328332e730","article-title":"Is there a relationship between obesity, heart rate variability, and inflammatory parameters in heart failure?","volume":"11","author":"Kocaman","year":"2010","journal-title":"J. Cardiovasc. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"57","DOI":"10.2147\/DMSO.S123935","article-title":"Association between obesity and heart rate variability indices: An intuition toward cardiac autonomic alteration\u2014A risk of CVD","volume":"10","author":"Yadav","year":"2017","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_45","first-page":"144","article-title":"Heart Rate Fluctuations and Late Ventricular Potentials in Depression Patients without Clinical Cardiovascular Disease","volume":"6","author":"Es","year":"2009","journal-title":"Eur. J. Gen. Med."},{"key":"ref_46","unstructured":"Riaz, B., Khan, M.A., Ali, H., and Majeed, S.M.I. (2018). Correlation of Signal Averaged ECG Parameters with Left Ventricular Mass Index in Patients with Systemic Arterial Hypertension. Pak. J. Physiol., 14."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1111\/j.1523-1755.2005.00365.x","article-title":"Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"67","author":"Levey","year":"2005","journal-title":"Kidney Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"15","DOI":"10.21037\/amj.2020.03.03","article-title":"Global epidemiology and future trends of heart failure","volume":"5","author":"Lippi","year":"2020","journal-title":"AME Med. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"4455","DOI":"10.1093\/eurheartj\/ehab579","article-title":"Novel biomarker-driven prognostic models to predict morbidity and mortality in chronic heart failure: The EMPEROR-Reduced trial","volume":"42","author":"Pocock","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_50","first-page":"313","article-title":"Prognostic value of Holter monitoring in congestive heart failure","volume":"15","author":"Cygankiewicz","year":"2008","journal-title":"Cardiol. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"20546","DOI":"10.1038\/s41598-021-99861-1","article-title":"Periodic repolarization dynamics as a predictor of the risk for sudden cardiac death in chronic heart failure patients","volume":"11","author":"Palacios","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1136\/heartjnl-2020-317833","article-title":"Association of heart failure and its comorbidities with loss of life expectancy","volume":"107","author":"Drozd","year":"2021","journal-title":"Heart"},{"key":"ref_53","first-page":"493","article-title":"Non-cardiovascular comorbidities in heart failure patients and their impact on prognosis","volume":"79","author":"Correale","year":"2021","journal-title":"Kardiol. Pol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/2047487320960288","article-title":"Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation","volume":"27","author":"Paolillo","year":"2020","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"76","DOI":"10.2459\/JCM.0b013e32834058d1","article-title":"Cardiovascular and noncardiovascular comorbidities in patients with chronic heart failure","volume":"12","author":"Metra","year":"2011","journal-title":"J. Cardiovasc. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/HCO.0000000000000257","article-title":"Heart failure with multiple comorbidities","volume":"31","author":"Moe","year":"2016","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.jchf.2014.08.004","article-title":"Impact of diabetes on epidemiology, treatment, and outcomes of patients with heart failure","volume":"3","author":"Khan","year":"2015","journal-title":"JACC Heart Fail."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1002\/ejhf.1170","article-title":"Type 2 diabetes mellitus and heart failure: A position statement from the Heart Failure Association of the European Society of Cardiology","volume":"20","author":"Petrie","year":"2018","journal-title":"Eur. J. Heart Fail."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Benichou, T., Pereira, B., Mermillod, M., Tauveron, I., Pfabigan, D., Maqdasy, S., and Dutheil, F. (2018). Heart rate variability in type 2 diabetes mellitus: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0195166"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1542-474X.2011.00437.x","article-title":"T-wave alternans and heart rate variability: A comparison in patients with myocardial infarction with or without diabetes mellitus","volume":"16","author":"Ren","year":"2011","journal-title":"Ann. Noninvasive Electrocardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.2147\/CIA.S149920","article-title":"Autonomic Function as Indicated by Heart Rate Deceleration Capacity and Deceleration Runs in Type 2 Diabetes Patients with or without Essential Hypertension","volume":"13","author":"Wang","year":"2018","journal-title":"Clin. Interv. Aging"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e016075","DOI":"10.1161\/JAHA.120.016075","article-title":"Heart Rate Variability Triangular Index as a Predictor of Cardiovascular Mortality in Patients With Atrial Fibrillation","volume":"9","author":"Eick","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"ehaa946.2438","DOI":"10.1093\/ehjci\/ehaa946.2438","article-title":"Impaired Heart Rate Variability Triangular Index to Identify Clinically Silent Strokes in Patients with Atrial Fibrillation","volume":"41","author":"Eick","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1002\/ejhf.1697","article-title":"Evaluation of kidney function throughout the heart failure trajectory\u2014A position statement from the Heart Failure Association of the European Society of Cardiology","volume":"22","author":"Mullens","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s10741-019-09869-z","article-title":"Hyperuricemia: A novel old disorder-relationship and potential mechanisms in heart failure","volume":"25","author":"Borghi","year":"2020","journal-title":"Heart Fail. Rev."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1253\/circj.CJ-15-0964","article-title":"Determinants and Prognostic Impact of Hyperuricemia in Hospitalization for Acute Heart Failure","volume":"80","author":"Huang","year":"2016","journal-title":"Circ. J."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1093\/eurheartj\/ehq473","article-title":"Hyperuricaemia, chronic kidney disease, and outcomes in heart failure: Potential mechanistic insights from epidemiological data","volume":"32","author":"Filippatos","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.ijcard.2009.01.010","article-title":"Association between hyperuricemia and incident heart failure among older adults: A propensity-matched study","volume":"142","author":"Ekundayo","year":"2010","journal-title":"Int. J. Cardiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.ijcard.2010.05.002","article-title":"Hyperuricemia predicts adverse outcomes in patients with heart failure","volume":"151","author":"Hamaguchi","year":"2011","journal-title":"Int. J. Cardiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1131566","DOI":"10.3389\/fendo.2023.1131566","article-title":"Joint association of hyperuricemia and chronic kidney disease with mortality in patients with chronic heart failure","volume":"14","author":"Wang","year":"2023","journal-title":"Front. Endocrinol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.numecd.2019.12.008","article-title":"Asymptomatic hyperuricemia and incident congestive heart failure in elderly patients without comorbidities","volume":"30","author":"Wu","year":"2020","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.hipert.2015.06.001","article-title":"Correlation of serum uric acid with heart rate variability in hypertension","volume":"32","author":"Kunikullaya","year":"2015","journal-title":"Hipertens. Riesgo Vasc."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1093\/ndt\/gfy255","article-title":"The potential of electrocardiography for cardiac risk prediction in chronic and end-stage kidney disease","volume":"34","author":"Skampardoni","year":"2019","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.18203\/2320-6012.ijrms20202264","article-title":"Evaluation of role of heart rate variability with Holter monitoring in chronic kidney disease","volume":"8","author":"Avula","year":"2020","journal-title":"Int. J. Res. Med. Sci."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Kida, N., Tsubakihara, Y., Kida, H., Ageta, S., Arai, M., Hamada, Y., and Matsuura, N. (2017). Usefulness of measurement of heart rate variability by Holter ECG in hemodialysis patients. BMC Nephrol., 18.","DOI":"10.1186\/s12882-016-0423-3"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.mayocp.2016.11.001","article-title":"Obesity and Heart Failure: Focus on the Obesity Paradox","volume":"92","author":"Carbone","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1002\/jcph.2193","article-title":"Prevalence of Baseline Cardiac Arrhythmias in Participants with Overweight or Obesity in Phase 1 Clinical Trials: Analysis of 24-Hour Holter Electrocardiogram Recordings","volume":"63","author":"Skovgaard","year":"2023","journal-title":"J. Clin. Pharmacol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1136\/heartjnl-2019-314770","article-title":"Complex interaction of obesity, intentional weight loss and heart failure: A systematic review and meta-analysis","volume":"106","author":"Mahajan","year":"2020","journal-title":"Heart"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.pcad.2020.09.005","article-title":"Implications of obesity across the heart failure continuum","volume":"63","author":"Elagizi","year":"2020","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1161\/01.HYP.0000255983.32896.b9","article-title":"Excessive Sympathetic Activation in Heart Failure with Obesity and Metabolic Syndrome: Characteristics and Mechanisms","volume":"49","author":"Grassi","year":"2007","journal-title":"Hypertension"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1161\/01.CIR.82.5.1724","article-title":"Comparison of Neuroendocrine Activation in Patients with Left Ventricular Dysfunction with and without Congestive Heart Failure. A Substudy of the Studies of Left Ventricular Dysfunction (SOLVD)","volume":"82","author":"Francis","year":"1990","journal-title":"Circulation"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.pcad.2012.09.001","article-title":"Heart rate variability today","volume":"55","author":"Xhyheri","year":"2012","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s10484-010-9133-y","article-title":"Biofeedback of heart rate variability and related physiology: A critical review","volume":"35","author":"Wheat","year":"2010","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"235","DOI":"10.30773\/pi.2017.08.17","article-title":"Stress and Heart Rate Variability: A Meta-Analysis and Review of the Literature","volume":"15","author":"Kim","year":"2018","journal-title":"Psychiatry Investig."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1111\/j.1540-8167.2005.40788.x","article-title":"Sometimes Higher Heart Rate Variability Is Not Better Heart Rate Variability: Results of Graphical and Nonlinear Analyses","volume":"16","author":"Stein","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"2885","DOI":"10.1016\/j.jacc.2017.04.001","article-title":"Heart Rate and Rhythm and the Benefit of Beta-Blockers in Patients With Heart Failure","volume":"69","author":"Kotecha","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_87","first-page":"10","article-title":"Multiparametric Implantable Cardioverter-Defibrillator Algorithm for Heart Failure Risk Stratification and Management: An Analysis in Clinical Practice","volume":"14","author":"Bianchi","year":"2021","journal-title":"Circ. Heart Fail."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"2469","DOI":"10.1002\/ehf2.14416","article-title":"Performance of a multisensor implantable defibrillator algorithm for heart failure monitoring related to co-morbidities","volume":"10","author":"Santobuono","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Rohrer, U., Manninger, M., Zirlik, A., and Scherr, D. (2022). Multiparameter Monitoring with a Wearable Cardioverter Defibrillator. Sensors, 22.","DOI":"10.3390\/s22010022"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.amjcard.2012.03.038","article-title":"Performance of the Seattle Heart Failure Model in Implantable Defibrillator Patients Treated with Cardiac Resynchronization Therapy","volume":"110","author":"Smith","year":"2012","journal-title":"Am. J. Cardiol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1111\/jce.15898","article-title":"Implantable Defibrillator-Detected Heart Failure Status Predicts Ventricular Tachyarrhythmias","volume":"34","author":"Compagnucci","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"ehaa946.0815","DOI":"10.1093\/ehjci\/ehaa946.0815","article-title":"Remote Monitoring Can Predict Lethal Arrhythmic Events Through Time-Domain Analysis of Heart Rate Variability in Patients with Implantable Cardioverter Defibrillator","volume":"41","author":"Shirakawa","year":"2020","journal-title":"Eur. Heart J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/2\/342\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:02:08Z","timestamp":1760104928000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/2\/342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,19]]},"references-count":92,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["medicina60020342"],"URL":"https:\/\/doi.org\/10.3390\/medicina60020342","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,19]]}}}