Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

Lin, Yu Hung; Lin, Chen; Ho, Yew Kam; Wu, Vin-Cent; Lo, Men Tzung; Hung, Kuo‐Chi; Liu, Li Yu Daisy; Lin, Lian Yu; Huang, Jenq‐Wen; Peng, Chung Kang

doi:10.1038/srep28202

Cited by 28 publications

(24 citation statements)

References 45 publications

(84 reference statements)

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“…In addition to atherosclerosis-related autonomic dysfunction, uremic autonomic neuropathy in ESRD patients has frequently been associated with parasympathetic damage and sympathetic nerve overactivity 38 , both of which have been associated with worse clinical outcomes in ESRD patients 39 . In our previous study, PD patients had significantly lower values of several linear and nonlinear parameters than those with normal renal function, and this also supports the hypothesis of prominent autonomic dysfunction in ESRD patients 40 .…”

Section: Discussionsupporting

confidence: 82%

The association between heart rhythm complexity and the severity of abdominal aorta calcification in peritoneal dialysis patients

Tsai

Lin

et al. 2018

Sci Rep

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Abdominal aorta calcification (AAC) has been associated with clinical outcomes in peritoneal dialysis (PD) patients. Heart rhythm complexity analysis has been shown to be a promising tool to predict outcomes in patients with cardiovascular disease. In this study, we aimed to analyze the association between heart rhythm complexity and AAC in PD patients. We prospectively analyzed 133 PD patients. Heart rhythm complexity including detrended fluctuation analysis and multiscale entropy was performed. In linear analysis, the patients in the higher AAC group (AAC ≥15%) had a significantly lower standard deviation of normal RR intervals, very low frequency, low frequency, high frequency and low/high frequency ratio. In non-linear analysis, DFAα1, slope 1–5, scale 5 and area 6–20 were significantly lower in the patients with higher AAC. Receiver operating characteristic curve analysis showed that DFAα1 had the greatest discriminatory power to differentiate these two groups. Multivariate logistic regression analysis showed that DFAα1 and HbA1c were significantly associated with higher AAC ratio. Adding DFAα1 significantly improved the discriminatory power of the linear parameters in both net reclassification improvement and integrated discrimination improvement models. In conclusion, DFAα1 is highly associated with AAC and a potential cardiovascular marker in PD patients.

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Section: Discussionsupporting

confidence: 82%

The association between heart rhythm complexity and the severity of abdominal aorta calcification in peritoneal dialysis patients

Tsai

Lin

et al. 2018

Sci Rep

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“…On the other hand, parasympathetic modulation was shown to be important in maintaining entropy at all time scales, with maximum effect (⌬) at scale six; however, its effect on fractal properties are at mid-term. Interestingly, previous studies with humans showed that MSE at scale five provides the greatest difference between healthy individuals and patients with diseases (14,30). Some authors also associated entropy at low time scales with respiratory modulation of HR, which is known to be associated with cardiac vagal control (14).…”

Section: An Integrative Viewmentioning

confidence: 99%

The role of sympathetic and vagal cardiac control on complexity of heart rate dynamics

Silva

Salgado

et al. 2017

American Journal of Physiology-Heart and Circulatory Physiology

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Analysis of heart rate variability (HRV) by nonlinear approaches has been gaining interest due to their ability to extract additional information from heart rate (HR) dynamics that are not detectable by traditional approaches. Nevertheless, the physiological interpretation of nonlinear approaches remains unclear. Therefore, we propose long-term (60 min) protocols involving selective blockade of cardiac autonomic receptors to investigate the contribution of sympathetic and parasympathetic function upon nonlinear dynamics of HRV. Conscious male Wistar rats had their electrocardiogram (ECG) recorded under three distinct conditions: basal, selective (atenolol or atropine), or combined (atenolol plus atropine) pharmacological blockade of autonomic muscarinic or β-adrenergic receptors. Time series of RR interval were assessed by multiscale entropy (MSE) and detrended fluctuation analysis (DFA). Entropy over short (1 to 5, MSE) and long (6 to 30, MSE) time scales was computed, as well as DFA scaling exponents at short (α, 5 ≤ ≤ 15), mid (α, 30 ≤ ≤ 200), and long (α, 200 ≤ ≤ 1,700) window sizes. The results show that MSE is reduced under atropine blockade and MSE is reduced under atropine, atenolol, or combined blockade. In addition, while atropine expressed its maximal effect at scale six, the effect of atenolol on MSE increased with scale. For DFA, α decreased during atenolol blockade, while the α increased under atropine blockade. Double blockade decreased α and increased α Results with surrogate data show that the dynamics during combined blockade is not random. In summary, sympathetic and vagal control differently affect entropy (MSE) and fractal properties (DFA) of HRV. These findings are important to guide future studies. Although multiscale entropy (MSE) and detrended fluctuation analysis (DFA) are recognizably useful prognostic/diagnostic methods, their physiological interpretation remains unclear. The present study clarifies the effect of the cardiac autonomic control on MSE and DFA, assessed during long periods (1 h). These findings are important to help the interpretation of future studies.

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“…In addition, Chiang et al also found that increased short-term fractal scaling exponent α1is an independent predictor for lower cardiac and total mortality in patients with ESRD receiving peritoneal dialysis [36] . However, Lin et al demonstrated that there were no significant differences in fractal scaling exponent (both α1and α2) for ESRD patients and those controls with normal renal function [38] . In the current study, we found that patients with ESRD had significantly lower α1 and higher α2 than those in healthy control subjects.…”

Section: Discussionmentioning

confidence: 99%

Heart Rhythm Complexity as Predictors for the Prognosis of End-Stage Renal Disease Patients Undergoing Hemodialysis

Liu

Zhan

Shi

et al. 2020

Preprint

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Objective Heart rhythm complexity, a measure of heart rate dynamics and a risk predictor in various clinical diseases, has not been systematically studied in patients with end-stage renal disease. The aim of this study is to investigate the heart rhythm complexity and its prognostic value for mortality in end-stage renal disease patients undergoing hemodialysis.Methods To assess heart rhythm complexity and conventional heart rate variability measures, 4-hour continuous electrocardiography for a retrospective cohort of 202 ostensibly healthy control subjects and 51 hemodialysis patients with end-stage renal disease were analyzed. Heart rhythm complexity was quantified by the complexity index from the measurement of the multiscale entropy profile.Results During a median follow-up of 13 months, 8 people died in the patient group. Values of either traditional heart rate variability measurements or complexity indices were found significantly lower in patients than those in healthy controls. In addition, the complexity indices (Area 1-5, Area 6-15 and Area 6-20) in the mortality group were significantly lower than those in the survival group, while there were no significant differences in traditional heart rate variability parameters between the two groups. In receiver operating characteristic curve analysis, Area 6-20 (AUC = 0.895, p<0.001) showed the strongest predictive power between mortality and survival groups.Conclusion The results suggest that heart rhythm complexity is impaired for patients with end-stage renal disease. Furthermore, the complexity index of heart rate variability quantified by multiscale entropy may be a powerful independent predictor of mortality in end-stage renal disease patients undergoing hemodialysis.

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Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

Cited by 28 publications

References 45 publications

The association between heart rhythm complexity and the severity of abdominal aorta calcification in peritoneal dialysis patients

The association between heart rhythm complexity and the severity of abdominal aorta calcification in peritoneal dialysis patients

The role of sympathetic and vagal cardiac control on complexity of heart rate dynamics

Heart Rhythm Complexity as Predictors for the Prognosis of End-Stage Renal Disease Patients Undergoing Hemodialysis

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