Prognostic role of short-term heart rate variability and deceleration/acceleration capacities of heart rate in extensive-stage small cell lung cancer

Abstract

Background: Prior research suggests that autonomic modulation investigated by heart rate variability (HRV) might act as a novel predictive biomarker for cancer prognosis, such as in breast cancer and pancreatic cancer. It is not clear whether there is a correlation between autonomic modulation and prognosis in patients with extensive-stage small cell lung cancer (ES-SCLC). Therefore, the purpose of the study was to examine the association between short-term HRV, deceleration capacity (DC) and acceleration capacity (AC) of heart rate and overall survival in patients with ES-SCLC.Methods: We recruited 40 patients with ES-SCLC, and 39 were included in the final analysis. A 5-min resting electrocardiogram of patients with ES-SCLC was collected using a microelectrocardiogram recorder to analyse short-term HRV, DC and AC. The following HRV parameters were used: standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD). Overall survival of patients with ES-SCLC was defined as time from the date of electrocardiogram measurement to the date of death or the last follow-up. Follow-up was last performed on 07 June 2023. There was a median follow-up time of 42.2 months.Results: Univariate analysis revealed that the HRV parameter SDNN, as well as DC significantly predicted the overall survival of ES-SCLC patients (all p < 0.05). Multivariate analysis showed that the HRV parameters SDNN (hazard ratio = 5.254, 95% CI: 1.817–15.189, p = 0.002), RMSSD (hazard ratio = 3.024, 95% CI: 1.093–8.372, p = 0.033), as well as DC (hazard ratio = 3.909, 95% CI: 1.353–11.293, p = 0.012) were independent prognostic factors in ES-SCLC patients.Conclusion: Decreased HRV parameters (SDNN, RMSSD) and DC are independently associated with shorter overall survival in ES-SCLC patients. Autonomic nervous system function (assessed based on HRV and DC) may be a new biomarker for evaluating the prognosis of patients with ES-SCLC.

How to properly evaluate cardiac vagal tone in oncology studies: a state-of-the-art review

“… rMSSD 12 PM 136 27±12 ms (n 6 = 228); 41±21 ms (n 68 = 543) 42±15 ms (n 86 = 21.438) Not a survival prognostic factor. 20 , 53 , 101 , 102 Significant correlation with PSA levels at 6 months. 102 All cancers 23.79±20.48 ms n 103 = 657; lung NSCLC 19.1±21.1 ms and prostate 32.34±40.25 ms, n 102 = 246; breast 19.8±8.5 ms (<18 months after surgery) and 15.0±6.0 ms (>18 months after surgery), n 95 = 30; leukemia 26±11 ms, n 137 = 36; ovarian cancer 11.5 ms (min = 1.70; max = 84.8), n 135 = 202.…”

“… DC No data. 6.5±2.0 ms (n 130 = 65); 7.2 ms (n 142 = 212) 12.40±5.46 ms (n 143 = 191) Poor prognosis for DC≤2.3 ms, n 53 = 39. Poor prognosis for DC≤4.5 ms, n 144 = 140.…”

“…DC is a measure of cardiac parasympathetic modulation capturing the lengthening of the RR interval over 2 to 4 successive beats; the opposite for AC. DC is more robust to artifacts and noise, 53 while AC describes SNS activity and is not a measure of cardiac vagal tone.…”

“…DC offers interesting prospects for the future as it could lead to less artifacts and may represent a relevant cardio vagal prognostic marker. 53 Kubios can be used for HRV analysis. Artifacts .…”