Bedside autonomic risk stratification after myocardial infarction by means of short-term deceleration capacity of heart rate

Rizas, Konstantinos D.; Eick, Christian; Doller, Angela Julia; Hamm, Wolfgang; Stuelpnagel, L Von; Zuern, Christine S.; Barthel, Petra; Schmidt, Georg; Bauer, Axel

doi:10.1093/europace/eux167

Cited by 26 publications

(16 citation statements)

References 19 publications

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“…Most importantly, DC ref from 2-h ECG recordings had the best discrimination power of all calculated DCs. Similar with a recent study [40], our findings also indicate that short-term DC ref , especially from 2-h ECG recordings may be a more useful and better index for autonomic bedside risk stratification that as complementary to traditional HRV measures and clinical factors.…”

Section: Discussionsupporting

confidence: 90%

A refined method of quantifying deceleration capacity index for heart rate variability analysis

et al. 2018

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BackgroundPhase-rectified signal averaging (PRSA) was often applied to assess the cardiac vagal modulation. Despite its broad use, this method suffers from the confounding effects of anomalous variants of sinus rhythm. This study aimed to improve the original PRSA method in deceleration capacity (DC) quantification.MethodsThe refined deceleration capacity (DCref) was calculated by excluding from non-vagally mediated abnormal variants of sinus rhythms. Holter recordings from 202 healthy subjects and 51 patients with end-stage renal disease (ESRD) have been used for validity. The DCref was compared to original DC (DCorg) by the area under receiver operating characteristic curve.ResultsExperimental results demonstrate that the original and refined DCs calculated from 24-h, 2-h, and 30-min Holter recordings are significantly lower in patients with ESRD than those in the healthy group. In receiver operating characteristic curve analysis, the DCref provides better performance than the DCorg in distinguishing between the patients with ESRD and healthy control subjects. Furthermore, the refined PRSA technique enhances the low frequency and attenuates high frequency components for spectral analysis in ESRD patients.ConclusionsThe DCref appears to reduce the influence of non-vagally mediated abnormal variants of sinus rhythm and highlighting the pathological influence. DCref, especially assessed from short-term electrocardiography recordings, may be complementary to existing autonomic function assessment, risk stratification, and efficacy prediction strategies.

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Section: Discussionsupporting

confidence: 90%

A refined method of quantifying deceleration capacity index for heart rate variability analysis

et al. 2018

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“…In the present study, DC cutoff value of 4.37 ms yielded sensitivity of 66.00% and specificity of 83.08% for predicting CAL, KD children with DC ≤ 4.37 ms (OR = 3.275) had an increased risk of CAL. In adults, it has been demonstrated that DC < 2.5 ms is significantly related to a higher risk of death after myocardial infarction, while DC > 4.5 ms is related to a lower risk 16,34 . Wei Hu's research found that DC was an independent risk factor for heart failure, with cutoff values of 4.55 ms in males and 4.85 ms in females 35 .…”

Section: Discussionmentioning

confidence: 99%

Predictive value of heart rate deceleration capacity on coronary artery lesion in acute phase of Kawasaki disease

Lü

Guo

et al. 2020

Sci Rep

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this study was to investigate the correlation of vagal activity with coronary artery lesion (cAL) in Kawasaki disease (KD) children, and assess the predictive value of heart rate deceleration capacity (DC) for CAL in acute phase of KD.50 KD children with CAL, 130 KD children without CAL, 30 children with acute upper respiratory infection and 100 healthy children were recruited and indicators reflecting vagal activity including Dc were measstuogram. KD children with cAL showed decreased vagal activity with significantly lower values of DC. DC was negatively correlated with levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) in KD children. DC was a usable cardiac electrophysiological index to predict cAL in children with KD, with an area under the receiver operating characteristic curve (AUC) of 0.741. The cutoff value of DC for predicting CAL in KD children was 4.37 ms. DC was an independent predictor of CAL in children with KD, evaluated by multiple logistic regression analysis, KD children with Dc ≤ 4.37 ms had an increased risk of CAL, with odds ratios (OR) of 5.94. Our study illustrates DC could be used to predict CAL in acute phase of KD. Kawasaki disease (KD) is an acute febrile systemic vasculitis syndrome, which is one of the most common acquired heart disease in children 1. Coronary artery lesion (CAL) as one of the most serious complications, which could result in coronary artery aneurysm, even myocardial infarction and sudden death, that cause serious damage to children's health, occurs in 25% of untreated children with KD 2-4. Studies have shown that some biochemical indicators are associated with CAL in KD, but there are relatively few reliable indicators for predicting CAL in the acute phase of disease 5-8. Heart rate variability (HRV) reflects beat-to-beat changes in RR intervals, which is a traditional, non-invasive method detecting autonomic nervous function. Root mean squared successive difference (rMSSD), percentage of successive normal sinus RR intervals >50 ms (PNN50) belongs to the time-domain variables of HRV, high frequency (HF) belongs to the frequency domain variable of HRV, low values for these indicators indicate hypoactivity of the vagal nerve 9-11. Decreased vagal activity has been found in patients with coronary artery disease in adults by HRV analysis, which is closely related to the prognosis and the severity of CAL 12-14. Since HRV method cannot accurately distinguish between the vagal and sympathetic activities of the autonomic nervous system, Heart rate deceleration capacity (DC) as a new indicator, which reflects the general trend of sinus rhythm RR interval and its ability to decelerate, has been discovered that can more accurately and quantitatively evaluate vagal activity and has a better warning ability of adverse cardiac events than HRV 15-18. In this study, we aimed to investigate the correlation of vagal activity with CAL in KD children, and assess the predictive value of DC for CAL in acute phase of KD.

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“…Des Weiteren lassen sich periodische Komponenten auch aus stark verrauschten Signalen zuverlässig und sensitiv extrahieren. Die [10,12]). DC: Deceleration Capacity auf der PRSA-Methode basierte "Dezelerationskapazität des Herzens" (Deceleration Capacity -DC) quantifiziert spezifisch dezelerationsbezogene und damit vornehmlich vagal modulierte Oszillationen der Herzfrequenz (▶ Abb.…”

Section: Methoden Zur Ekg-basierten Risikoanalyseunclassified

“…In den ersten Studien wurde DC aus 24-Stunden-Aufzeichnungen gemessen. Eine neuere Studie konnte zeigen, dass sich DC auch aus 20-minütigen Kurzzeitmessungen berechnen lässt, was die praktische Anwendbarkeit im klinischen Alltag deutlich erleichtern kann [12].…”

Section: Methoden Zur Ekg-basierten Risikoanalyseunclassified

Risikostratifizierung für plötzlichen Herztod nach Myokardinfarkt jenseits der LV-Funktion

Klemm

Bauer

2018

Aktuel Kardiol

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ZusammenfassungDer plötzliche Herztod (PHT) ist die häufigste Einzeltodesursache in der westlichen Welt. Insbesondere Patienten nach Myokardinfarkt und mit Herzinsuffizienz weisen ein erhöhtes Risiko auf. Der Nachweis einer hochgradig eingeschränkten linksventrikulären Funktion gilt als der Goldstandard in der Identifikation von Hochrisikopatienten, allerdings sind Sensitivität und Spezifität dieses Kriteriums unzureichend. So werden mehr als zwei Drittel der Patienten, die in der Folgezeit nach Herzinfarkt versterben, nicht korrekt als Hochrisikopatienten identifiziert. Biosignalbasierte Parameter, welche Störungen des kardialen autonomen Nervensystems quantifizieren, erlauben es möglicherweise, Hochrisikopatienten unabhängig von der Pumpleistung des Herzens zu identifizieren. Diese Marker können mittels mathematischer Methoden aus herkömmlichen Oberflächen-EKGs berechnet werden. SMART-MI ist eine randomisierte Interventionsstudie, die einen neuen Ansatz der personalisierten Postinfarkttherapie bei Patienten mit autonomer Dysfunktion und nur moderat eingeschränkter linksventrikulärer Pumpfunktion untersucht.

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Bedside autonomic risk stratification after myocardial infarction by means of short-term deceleration capacity of heart rate

Abstract: Deceleration capacity assessed from short-term recordings is a strong and independent predictor of mortality and cardiovascular mortality after MI, which is complementary to existing risk stratification strategies.

Cited by 26 publications

References 19 publications

A refined method of quantifying deceleration capacity index for heart rate variability analysis

A refined method of quantifying deceleration capacity index for heart rate variability analysis

Predictive value of heart rate deceleration capacity on coronary artery lesion in acute phase of Kawasaki disease

Risikostratifizierung für plötzlichen Herztod nach Myokardinfarkt jenseits der LV-Funktion

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