Deceleration Capacity of Heart Rate Predicts Arrhythmic and Total Mortality in Heart Failure Patients

Αρσένος, Πέτρος; Manis, George; Gatzoulis, Konstantinos; Dilaveris, Polychronis; Gialernios, Theodoros; Angelis, Athanasios; Papadopoulos, A; Venieri, Erifili; Trikas, Athanasios; Tousoulis, Dimitris

doi:10.1111/anec.12343

Cited by 23 publications

(23 citation statements)

References 28 publications

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“…In a study by Arsenos et al, DC was found to be an independent predictor of sudden cardiac death. 19 In our previous study, patients with acute exacerbation of COPD with concomitant ventricular arrhythmias showed an association with reduced DC, which suggests its value as an indicator of autonomic dysfunction. 20 A recent study also found that DC can help stratify COPD patients based on their risk of arrhythmias.…”

Section: Introductionmentioning

confidence: 86%

“…Arsenos et al validated the application of DC for predicting the risk of arrhythmias in patients with heart failure; they found that DC ≤3.352 ms was significantly associated with increased incidence of arrhythmias. 19 Buzea et al further evaluated the ability of DC to predict the development of arrhythmias in COPD patients; they also found a significant correlation between DC and the incidence of arrhythmias. 21 Based on the results of ROC curve analysis in our study, DRs were found to be a robust predictor of supraventricular and ventricular arrhythmias.…”

Section: Copdmentioning

confidence: 99%

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<p>Risk Prediction for Arrhythmias by Heart Rate Deceleration Runs in Patients with Chronic Obstructive Pulmonary Disease</p>

Kong¹,

Wang²,

Shen³

et al. 2020

COPD

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Purpose: Chronic obstructive pulmonary disease (COPD) is associated with increased incidence of arrhythmias, which has been attributed to autonomic dysregulation. Detection of autonomic function may facilitate stratification of COPD patients with respect to their risk of development of arrhythmias. Patients and Methods: A total of 151 COPD patients and 45 non-COPD patients were included in this study. Heart rate deceleration runs (DRs) were detected by dynamic electrocardiogram (ECG); DRs successively occurring in 2, 4, or 8 cardiac cycles were denoted as DR 2 , DR 4 , and DR 8 , respectively. Indicators of arrhythmias including isolated premature atrial contractions (PAC), supraventricular tachycardia (SVT), isolated premature ventricular contractions (PVC), and ventricular tachycardia (VT) were recorded. Occurrence of SVT or PAC ≥70/day was considered positive for supraventricular arrhythmias, while positive ventricular arrhythmias category (PVAC) was defined as occurrence of VT or PVC ≥10/hour. Results: Compared with non-COPD individuals, COPD patients were associated with increased number of PAC, PVC, higher incidence of PAC >70/d, SVT, PVAC, and decreased DRs (DR2, DR4, DR8) (P<0.05). In COPD patients, DRs showed a negative correlation with the incidence of PAC, PVC, SVT, and PVAC (P<0.05). In receiver operating characteristic curve analysis, all the DRs were found to be significant predictors of PAC >70/d, SVT, and PVAC. The predictive power of DRs was significantly different from one another with the order ranged as DR4>DR8>DR2 for PAC >70/d, DR8>DR4>DR2 for SVT, and DR8>DR4>DR2 for PVAC. Conclusion: Our study provides evidence of significant autonomic dysregulation in COPD patients. DRs may serve as a marker of the risk of arrhythmias in COPD patients.

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Section: Introductionmentioning

confidence: 86%

Section: Copdmentioning

confidence: 99%

<p>Risk Prediction for Arrhythmias by Heart Rate Deceleration Runs in Patients with Chronic Obstructive Pulmonary Disease</p>

Kong¹,

Wang²,

Shen³

et al. 2020

COPD

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“…In a recent systematic review, HRT showed a consistent predictive value for cardiac death and arrhythmic events (Disertori, Mase, Rigoni, Nollo, & Ravelli, 2016). DC has been shown to be an independent predictor of both SCD and total mortality (Arsenos et al, 2016). DC can be interpreted as a global measure of heart rate deceleration as it is an integral measure of all deceleration-related periodic components of the heart rate over a 24-hr period (Bauer et al, 2009).…”

Section: Selected Parametersmentioning

confidence: 99%

“…DC can be interpreted as a global measure of heart rate deceleration as it is an integral measure of all deceleration-related periodic components of the heart rate over a 24-hr period (Bauer et al, 2009). DC has been shown to be an independent predictor of both SCD and total mortality (Arsenos et al, 2016). However, as ventricular arrhythmias can be considered a coincidence of circumstances, we hypothesize that a global measure of autonomic function, as DC, could yield a higher predictive value than a rather specific measure related to VPBs, as HRT.…”

Section: Selected Parametersmentioning

confidence: 99%

Combining noninvasive risk stratification parameters improves the prediction of mortality and appropriate ICD shocks

Vandenberk

Junttila

Robyns

et al. 2018

Noninvasive Electrocardiol

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Background: Sudden cardiac death (SCD) results from a complex interplay of abnormalities in autonomic function, myocardial substrate and vulnerability. We studied whether a combination of noninvasive risk stratification tests reflecting these key players could improve risk stratification. Methods:Patients implanted with an ICD in whom 24-hr holter recordings were available prior to implant were included. QRS fragmentation (fQRS) was selected as measure of myocardial substrate and a high ventricular premature beat count (VPB >10/hr) for arrhythmic vulnerability. From receiver operating characteristics analysis, detrended fluctuation analysis (DFA), turbulence slope, and deceleration capacity were selected for autonomic function. Adjusted Cox regression analysis with comparison of C-statistics was performed to predict first appropriate shock (AS) and total mortality. Results:A total of 220 patients were included in the analysis with an overall followup of 4.3 ± 3.1 years. A model including VPB >10/hr, inferior fQRS, and abnormal nonedited DFA was the best for prediction of AS after 1 year of follow-up with a trends toward improvement of the C-statistics compared to baseline (p = 0.055). The risk increased significantly with every abnormal test (HR 1.793, 95%CI 1.255-2.564).A model including fQRS in any region and abnormal edited DFA was the best for prediction of mortality after 3 years of follow-up with significant improvement of the C-statistics (p = 0.023). Each abnormal test was associated with a significant increase in mortality (HR 5.069, 95%CI 1.978-12.994). Conclusion:Combining noninvasive risk stratification tests according to their physiological background can improve the risk prediction of SCD and mortality. K E Y W O R D Sheart rate variability, implantable cardioverter-defibrillator, sudden cardiac death

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“…A variety of other noninvasive indices from 12‐lead ECG, SAECG and 24‐hour electrocardiography have been suggested, although results were not always consistent; such ECG‐indices included wide or fragmented QRS complex, prolonged QTc interval, nonsustained VT of ≥10 QRS complexes, baroreflex sensitivity or inverse spatial QRS‐T angle (Goldberger et al., ; Huikuri et al., ). Lastly, indices of autonomic function, such as reduced heart rate variability (Arsenos et al., ; Huikuri et al., ), abnormal heart rate turbulence (HRT) or deceleration capacity (Arsenos et al., ), have been widely explored but results have once more been ambiguous (Goldberger, Subačius, Patel, Cunnane, & Kadish, ). It should be noted that autonomic nervous system dysfunction indices have been related more with nonsudden cardiac mortality (Goldberger et al., ; Hayano et al., ).…”

Section: The Multifactorial Approachmentioning

confidence: 99%

Arrhythmic risk stratification in heart failure: Time for the next step?

Gatzoulis

Sideris

Kanoupakis

et al. 2017

Ann Noninvasive Electrocardiol

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Deceleration Capacity of Heart Rate Predicts Arrhythmic and Total Mortality in Heart Failure Patients

Abstract: DC predicts both SCD and TM. DCsgn avoids the negative values, improving the method in a nonstatistical important level.

Cited by 23 publications

References 28 publications

<p>Risk Prediction for Arrhythmias by Heart Rate Deceleration Runs in Patients with Chronic Obstructive Pulmonary Disease</p>

<p>Risk Prediction for Arrhythmias by Heart Rate Deceleration Runs in Patients with Chronic Obstructive Pulmonary Disease</p>

Combining noninvasive risk stratification parameters improves the prediction of mortality and appropriate ICD shocks

Arrhythmic risk stratification in heart failure: Time for the next step?

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