In TR patients undergoing TTVI, higher average nighttime heart rate increased 2-year mortality risk (HR 1.038, p=0.024); cluster with higher night HR had 39% vs 27% mortality.
Do specific 24-hour wearable heart rate patterns predict 2-year all-cause mortality in right-sided heart failure patients with tricuspid regurgitation undergoing TTVI?
Circadian heart rate patterns derived from wearable devices, specifically higher nighttime heart rate, are associated with increased 2-year mortality in patients with tricuspid regurgitation undergoing transcatheter intervention.
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Abstract Background Despite the significant mortality associated with Tricuspid Regurgitation (TR), the prognostic value of heart rate data recorded in daily life among TR patients remains largely understudied. Methods A retrospective analysis was performed using data from 338 patients who underwent Transcatheter Tricuspid Valve Intervention (TTVI) between 2017 and 2023. Patients were provided with wearable Fitbit devices prior to TTVI and at 3 intervals (3 months, 3-6 months, ≥12 months) following the procedure. Harmonic modelling was applied to these measurements to estimate the intercept, amplitude, and phase parameters for the best-fit harmonics. This modelling was employed to capture and quantify the inherently cyclical (circadian) fluctuations in heart rate over 24 hours. From the fitted waveforms, the overall amplitude (minimum–maximum), average daytime and nighttime heart rates, and daytime and nighttime amplitudes values were extracted. K-means clustering with UMAP-based dimensionality reduction was applied to explore the characteristics of common patterns and their relation to clinical outcomes. A Markov-based algorithm was applied for cluster imputation. 2-year all-cause mortality and clinical success, defined as post-TTVI TR grade = 2, were used as clinical outcomes. Results The median heart rate tracking duration was 8 (IQR 5-11) days. 2-year all-cause mortality was observed in 31% of the patient cohort while 90% achieved early clinical success after TTVI. A total of 2 clusters were identified. Cluster 1 had lower overall amplitude 9.5 vs 16.2, higher nighttime heart rate 72 vs 69, lower nighttime amplitude 7.0 vs 12.3, and higher mortality 39% vs 27%, when compared with cluster 2. Kaplan–Meier analysis showed a statistically significant difference in survival between the two groups (log-rank test statistic = 3.95, p = 0.047). Univariate Cox regression model with a 2-sided Bonferroni correction indicated that average nighttime heart rate HR = 1.038, 95% CI: 1.011 - 1.066, p= 0.024 was associated with 2-year all-cause mortality. No statistically significant difference in wearable heart rate data was observed between the clinical success groups. Conclusion In this cohort of TR patients, baseline heart rate clustering was associated with 2-year mortality, highlighting the potential clinical relevance of circadian heart rate fluctuations. Identifying heart rate patterns could aid in early risk stratification and targeted interventions, potentially improving patient outcomes.Clusters' 24 Hour Patterns Kaplan–Meier 2-Year Survival Probability
Idakwo et al. (Sat,) reported a other. In TR patients undergoing TTVI, higher average nighttime heart rate increased 2-year mortality risk (HR 1.038, p=0.024); cluster with higher night HR had 39% vs 27% mortality.