Early Loss of Heart Rate Complexity Predicts Mortality Regardless of Mechanism, Anatomic Location, or Severity of Injury in 2178 Trauma Patients

Riordan, William P.; Norris, Pippa; Jenkins, Judith M.; Morris, John A.

doi:10.1016/j.jss.2009.03.086

Cited by 74 publications

(64 citation statements)

References 23 publications

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“…1,6,11 This may explain differing performances with respect to predictive ability over other frequency domain parameters in the intensive care setting. 3 HRV is increasingly gaining popularity as a predictor of outcome in a variety of clinical environments, including trauma patients, 12 critically ill emergency department 4 patients, 13 septic patients on admission to ED, 14 and the haemodynamically stable trauma patient. 15 It has also been used to predict outcomes such as hypotension during obstetric spinal hypotension.…”

Section: Discussionmentioning

confidence: 99%

Heart rate variability predicts 30-day all-cause mortality in intensive care units

Bishop

Wise

Lee

et al. 2016

Southern African Journal of Anaesthesia and Analgesia

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Background: Autonomic nervous function, as quantified by heart rate variability (HRV), has shown promise in predicting clinically important outcomes in the critical care setting; however, there is debate concerning its utility. HRV analysis was assessed as a practical tool for outcome prediction in two South African hospitals and compared with Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring. Method: In a dual centre, prospective, observational cohort study of patients admitted to the intensive care units (ICU) of two hospitals in KwaZulu-Natal, South Africa frequency domain HRV parameters were explored as predictors of: all-cause mortality at 30 days after admission; ICU stay duration; the need for invasive ventilation; the need for inotrope/vasopressor therapy; and the need for renal replacement therapy. The predictive ability of HRV parameters against the APACHE II score for the study outcomes was also compared. Results: A total of 55 patients were included in the study. Very low frequency power (VLF) was shown to predict 30-day mortality in ICU (odds ratio 0.6; 95% confidence interval 0.396-0.911). When compared with APACHE II, VLF remained a significant predictor of outcome, suggesting that it adds a unique component of prediction. No HRV parameters were predictive for the other secondary outcomes. Conclusion: This study found that VLF independently predicted all-cause mortality at 30 days after ICU admission. VLF provided additional predictive ability above that of the APACHE II score. As suggested by this exploratory analysis larger multi-centre studies seem warranted.

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Section: Discussionmentioning

confidence: 99%

Heart rate variability predicts 30-day all-cause mortality in intensive care units

Bishop

Wise

Lee

et al. 2016

Southern African Journal of Anaesthesia and Analgesia

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“…To assess the fidelity of the tachograms of different pulse detection methods to nonlinear aspects of the R-R tachogram, the entropy difference (|HRV Ϫ PRV|) for each scale factor was computed for each baseline recording. For the remainder of the study, we used the sum of the entropy over all the computed scales to represent multiscale entropy because of its prognostic value in large patient studies (21,22,26). All other nonlinear indexes were computed in Kubios HRV, including Shannon, approximate, and sample entropy.…”

Section: Nonlinear Indexesmentioning

confidence: 99%

“…Nonlinear measures encompass a heterogeneous group of statistics, several of which quantify the entropy or complexity of the signal. Multiscale sample entropy is one such statistic that has been used to distinguish patients with cardiovascular pathologies from healthy subjects (10,29,30) and is predictive of mortality in trauma and heart failure patients (17,21,22,26).…”

mentioning

confidence: 99%

Validation of pulse rate variability as a surrogate for heart rate variability in chronically instrumented rabbits

Pellegrino

Schiller

Zucker

2014

American Journal of Physiology-Heart and Circulatory Physiology

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Pellegrino PR, Schiller AM, Zucker IH. Validation of pulse rate variability as a surrogate for heart rate variability in chronically instrumented rabbits. Am J Physiol Heart Circ Physiol 307: H97-H109, 2014. First published May 2, 2014; doi:10.1152/ajpheart.00898.2013.-Heart rate variability (HRV) is a function of cardiac autonomic tone that is widely used in both clinical and animal studies. In preclinical studies, HRV measures are frequently derived using the arterial pulse waveform from an implanted pressure telemetry device, termed pulse rate variability (PRV), instead of the electrocardiogram signal in accordance with clinical guidelines. The acceptability of PRV as a surrogate for HRV in instrumented animals is unknown. Using rabbits implanted with intracardiac leads and chronically implanted pressure transducers, we investigated the correlation and agreement of timedomain, frequency-domain, and nonlinear indexes of HRV and PRV at baseline. We also investigated the effects of ventricular pacing and autonomic blockade on both measures. At baseline, HRV and PRV time-and frequency-domain parameters showed robust correlations and moderate to high agreement, whereas nonlinear parameters showed slightly weaker correlations and varied agreement. Ventricular pacing almost completely eliminated HRV, and spectral analysis of the PRV signal revealed a HRV-independent rhythm. After cardiac autonomic blockade with atropine or metoprolol, the changes in timeand non-normalized frequency-domain measures of PRV continued to show strong correlations and moderate to high agreement with corresponding changes in HRV measures. Blockade-induced changes in nonlinear PRV indexes correlated poorly with HRV changes and showed weak agreement. These results suggest that time-and frequency-domain measures of PRV are acceptable surrogates for HRV even in the context of changing cardiac autonomic tone, but caution should be used when nonlinear measures are a primary end point or when HRV is very low as HRV-independent rhythms may predominate.heart rate variability; pulse rate variability; pulse interval; sympathovagal balance

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“…Very few studies however have examined the relationship between pre-operative heart rate variability and post-operative outcome [29]. Our observations therefore add a new temporal dimension (the intraoperative period) to the previously published data indicating that markers of autonomic dysfunction may serve as clinically useful tools in the evaluation and management of the critically ill [30][31][32][33].…”

Section: Discussionmentioning

confidence: 73%

Low intraoperative heart rate volatility is associated with early postoperative mortality in general surgical patients: a retrospective case–control study

Mandel-Portnoy

Levin

Bansilal

et al. 2015

J Clin Monit Comput

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Heart rate volatility (HRVO) is hypothesized to be a physiological measure of sympathetic activity and is defined by the standard deviation (SD) of the heart rate (HR) in beats per minutes (BPM) over fixed time intervals. To investigate the relationship between low HRVO (SD < 0.5 BPM) during surgical procedures and mortality within 48 h post-procedure. We retrospectively reviewed all adult general surgical procedures performed at our center from January 1, 2003 through July 1, 2013 to identify patients who died within 48 h post-procedure. Demographic, heart rate, and mortality data were extracted from the electronic anesthesia record. Propensity score analysis was used to find matching controls based on age, gender, ASA score, anesthesia type, Charlson index, procedure type, emergency status, year, use of preoperative beta blocker, hypertension, diabetes, atrial fibrillation and heart failure. HRVO was calculated for each 5 min interval as the SD of all HR's within that interval. Negative binomial regression was then used to model the count of intervals with HRVO < 0.5 BPM for the duration of the surgery. During the 10 year study period, 283 patients died within 48 h of procedure finish. These patients were matched to 566 patients who did not die within 48 h after procedure. Patients who died had a 39 % increase in frequency of low HRVO episodes compared to patients who survived (RR 1.39, 95 % CI 1.13-1.72; p = 0.003). Low HRVO during surgical procedure is associated with increased mortality risk within 48 h after procedure. Strategies to identify HRVO early and modify it may lead to improvement in outcomes.

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Early Loss of Heart Rate Complexity Predicts Mortality Regardless of Mechanism, Anatomic Location, or Severity of Injury in 2178 Trauma Patients

Cited by 74 publications

References 23 publications

Heart rate variability predicts 30-day all-cause mortality in intensive care units

Heart rate variability predicts 30-day all-cause mortality in intensive care units

Validation of pulse rate variability as a surrogate for heart rate variability in chronically instrumented rabbits

Low intraoperative heart rate volatility is associated with early postoperative mortality in general surgical patients: a retrospective case–control study

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