Raw skin sympathetic nerve activity complexity measures independently predicted sudden and non-sudden cardiac death in heart failure patients (HR ≈ 0.75-0.80, p<0.05).
Cohort (n=588)
Does skin sympathetic nerve activity complexity predict sudden and nonsudden cardiac mortality in heart failure patients?
Skin sympathetic nerve activity complexity measures, particularly multiscale entropy, provide non-invasive prognostic information for cardiac death in heart failure patients beyond established clinical predictors.
Estimación del efecto: HR ≈ 0.75-0.80
valor p: p=<0.05
BACKGROUND Heart failure is a global health challenge with a significant impact on patients and healthcare systems. Identifying those at risk of cardiac death remains difficult but essential. Elevated sympathetic nerve activity (SNA) is linked to ventricular arrhythmias, highlighting its value in diagnosis and risk stratification. OBJECTIVE Investigate the use of skin SNA (SKNA) as a marker for stratifying patients at risk of cardiac death beyond established clinical predictors and heart rate variability (HRV). METHODS We analyzed 20-min, 1-kHz orthogonal ECG recordings from 588 HF patients in the MUSIC dataset after excluding device carriers. SKNA was extracted using high-pass filtering (>300 Hz). We quantified traditional amplitude-based SKNA metrics derived from moving average (MA) and root mean square (RMS) signals, and raw-signal (rSKNA) distribution and nonlinear complexity features, including largest Lyapunov exponent (LE) and multiscale entropy (MSE). Associations with outcomes were assessed using univariate analyses and multivariable Cox models adjusted for age, BMI, LVEF, NYHA class, diabetes, and prior myocardial infarction. HRV indices (SDNN, LF/HF) were evaluated for comparison. RESULTS MA/RMS-based SKNA metrics did not show consistent between-group differences. In contrast, rSKNA complexity measures (LE and MSE) were lower in patients who experienced cardiac death (sudden and non-sudden). In adjusted Cox models, LE and MSE remained independently associated with cardiac death (HR ≈ 0.75-0.80, p<0.05), whereas SDNN and LF/HF were not independently associated. CONCLUSION rSKNA complexity measures, particularly MSE, provide complementary, non-invasive prognostic information for sudden and non-sudden cardiac death in HF beyond established clinical predictors and HRV.
Aranda-Hernandez et al. (Sun,) conducted a cohort in Heart failure (n=588). Skin sympathetic nerve activity (SKNA) complexity measures vs. Established clinical predictors and heart rate variability (HRV) was evaluated on Cardiac death (sudden and non-sudden) (HR ≈ 0.75-0.80, p=<0.05). Raw skin sympathetic nerve activity complexity measures independently predicted sudden and non-sudden cardiac death in heart failure patients (HR ≈ 0.75-0.80, p<0.05).