HRT assessment reviewed: a systematic review of heart rate turbulence methodology

Abstract

Heart rate turbulence (HRT) is a biphasic reaction to a ventricular premature contraction (VPC) mainly mediated by the baroreflex. It can be used for risk stratification in different disease patterns. Despite existing standards there is a lot of variation in terms of measuring and calculating HRT, which complicates research and application. Objective: This systematic review outlines and evaluates the methodological spectrum of HRT research, especially filtering criteria, parameter calculation and thresholds. Approach: The analysis includes all research papers written in English that have been published before 12.10.2018, are listed on PubMed and involve calculation of HRT parameter values. Main results: HRT assessment is still being performed in various ways and important specifications of the methodology are not given in many articles. Nevertheless, some suggestions regarding HRT methodology can be made: a normalised turbulence slope should be used to uncouple the parameter from heart rate and frequency of extrasystoles. Filtering criteria as formerly reviewed in the guidelines should be met and mentioned. The minimal number of VPC snippets (VPCSs) as well as new cut-off values for different risks need to be further evaluated. Most importantly, the exact and complete methodology must be described to ensure reproducibility and comparability. Significance: Methodical variation hinders comparability of research and medical application. Our continuing questions help to further standardise the measurement and calculation of HRT and increase its value for medical risk stratification.

Comparability of Heart Rate Turbulence Methodology: 15 Intervals Suffice to Calculate Turbulence Slope – A Methodological Analysis Using PhysioNet Data of 1074 Patients

“…Possibly, DTW could replace the original HRT parameters, because it analyzes the tachogram as a whole instead of reducing it to selective parameters that can be biased as seen in this study with TS. Using DTW for HRT analysis needs establishing the mentioned stVPCSs through a sufficiently large data set with fitting health conditions and with respect to factors influencing HRT like age or circadian rhythm ( 31 ). A similar approach has already been done by Martínez et al ( 44 ) based on a Neyman-Pearson detector ( 44 ) that compares a VPCS to the first three functions of a Karhunen-Loève transform expansion ( 45 , 46 ).…”

“…The package can be found on The Comprehensive R Archive Network (CRAN) ( https://CRAN.R-project.org/package=RHRT ) and on github ( https://github.com/VBlesius/RHRT ). The default methodology of filtering, calculation, and classification is done as suggested in Blesius et al ( 31 ), which mostly follows the ISHNE consensus ( 16 ). In contrast to the standards, we use 5 instead of 2 RR intervals in a VPCS before the couplI (preRRs), because the preceding intervals are used to calculate the reference interval (refI) and must, therefore, be included in the filtering process.…”

“…For HRT, a standard methodology has been published in the “International Society for Holter and Noninvasive Electrocardiology (ISHNE)” Consensus ( 16 ). However, many studies still use different methods to assess HRT ( 31 ) causing the aforementioned difficulties.…”

Altered Heart Rate Turbulence and Variability Parameters Predict 1-Year Mortality in Heart Failure with Preserved Ejection Fraction

“…Importantly, HRT analysis has several limitations, especially when the methodology is not depicted accurately [ 20 , 21 , 22 , 23 , 24 ]. For this reason, all our patients included in the final analysis met all inclusion criteria, and no exclusion criteria regarding the strict HRT methodology were set by the primary authors [ 20 ].…”

RHRT: An R package to assess Heart Rate Turbulence

“…However, analysis of the methodology of HRT assessment is still needed (Blesius et al, 2020), because optimal filtering and calculation parameters have not been systematically assessed yet. Variations in methodology can lead to less comparable or even conflicting data and reduce the validity of HRT.…”