TY - JOUR
TI - Deceleration Capacity of Heart Rate Predicts Arrhythmic and Total Mortality in Heart Failure Patients
AU - Arsenos, P.
AU - Manis, G.
AU - Gatzoulis, K.A.
AU - Dilaveris, P.
AU - Gialernios, T.
AU - Angelis, A.
AU - Papadopoulos, A.
AU - Venieri, E.
AU - Trikas, A.
AU - Tousoulis, D.
JO - Annals of Noninvasive Electrocardiology
PY - 2016
VL - 21
TODO - 5
SP - 508-518
PB - Blackwell Publishing Inc.
SN - 1082-720X, 1542-474X
TODO - 10.1111/anec.12343
TODO - amiodarone;  hydroxymethylglutaryl coenzyme A reductase inhibitor, adult;  age;  Article;  cardiovascular mortality;  cardiovascular system examination;  controlled clinical trial;  controlled study;  deceleration;  deceleration capacity characterized by the sign of the fraction method;  deceleration capacity original method;  echocardiography;  electrophysiological procedures;  female;  heart arrhythmia;  heart failure;  heart left ventricle ejection fraction;  heart rate;  heart ventricle extrasystole;  heart ventricle fibrillation;  heart ventricle tachycardia;  high risk patient;  human;  hypertension;  implantable cardioverter defibrillator;  intermethod comparison;  major clinical study;  male;  middle aged;  New York Heart Association class;  observational study;  priority journal;  prospective study;  QRS interval;  QTc interval;  receiver operating characteristic;  sudden cardiac death;  time series analysis
TODO - Background: Deceleration capacity (DC) of heart rate proved an independent mortality predictor in postmyocardial infarction patients. The original method (DCorig) may produce negative values (9% in our analyzed sample). We aimed to improve the method and to investigate if DC also predicts the arrhythmic mortality. Methods: Time series from 221 heart failure patients was analyzed with DCorig and a new variant, the DCsgn, in which decelerations are characterized based on windows of four consecutive beats and not on anchors. After 41.2 months, 69 patients experienced sudden cardiac death (SCD) surrogate end points, while 61 died. Results: (SCD+ vs SCD-group) DCorig: 3.7 ± 1.6 ms versus 4.6 ± 2.6 ms (P = 0.020) and DCsgn: 4.9 ± 1.7 ms versus 6.1 ± 2.2 ms (P < 0.001). After Cox regression (gender, age, left ventricular ejection fraction, filtered QRS, NSVT≥1/24h, VPBs≥240/24h, mean 24-h QTc, and each DC index added on the model separately), DCsgn (continuous) was an independent SCD predictor (hazard ratio [H.R.]: 0.742, 95% confidence intervals (C.I.): 0.631–0.871, P < 0.001). DCsgn ≤ 5.373 (dichotomous) presented 1.815 H.R. for SCD (95% C.I.: 1.080–3.049, P = 0.024), areas under curves (AUC)/receiver operator characteristic (ROC): 0.62 (DCorig) and 0.66 (DCsgn), P = 0.190 (chi-square). Results for deceased versus alive group: DCorig: 3.2 ± 2.0 ms versus 4.8 ± 2.4 ms (P < 0.001) and DCsgn: 4.6 ± 1.4 ms versus 6.2 ± 2.2 ms (P < 0.001). In Cox regression, DCsgn (continuous) presented H.R.: 0.686 (95% C.I. 0.546–0.862, P = 0.001) and DCsgn ≤ 5.373 (dichotomous) presented an H.R.: 2.443 for total mortality (TM) (95% C.I. 1.269–4.703, P = 0.008). AUC/ROC: 0.71 (DCorig) and 0.73 (DCsgn), P = 0.402. Conclusions: DC predicts both SCD and TM. DCsgn avoids the negative values, improving the method in a nonstatistical important level. © 2016 Wiley Periodicals, Inc.
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