What is the clinical evidence from this study?

Study design: Observational. Population: Long QT syndrome type 1 (LQT1). Intervention: KCNQ1-A341V mutation vs. Non-mutation carriers. Primary outcome: Differences in refined multiscale conditional entropy (RMSCE) and self-entropy (RMSsE) over heart period and QT interval.

November 19, 2015Open Access

A Refined Multiscale Self-Entropy Approach for the Assessment of Cardiac Control Complexity: Application to Long QT Syndrome Type 1 Patients

Key Result

Joint evaluation of refined multiscale conditional entropy and self-entropy over heart period and QT interval distinguished asymptomatic and symptomatic LQT1 mutation carriers from non-carriers.

Study Design

Type

Observational

Structured PICO

Does refined multiscale self-entropy and conditional entropy analysis of Holter ECGs distinguish between symptomatic and asymptomatic LQT1 mutation carriers?

Population

LQT1 patients featuring the KCNQ1-A341V mutation, subdivided into asymptomatic and symptomatic carriers, and non-mutation carriers evaluated via 24-hour Holter ECGs.

Exposure

Refined multiscale conditional entropy (RMSCE) and self-entropy (RMSsE) analysis of heart period and QT interval derived from 24-hour Holter electrocardiographic recordings

Comparator

Non-mutation carriers (NMCs) and comparison between asymptomatic and symptomatic mutation carriers

Outcome

Differentiation of experimental conditions (day vs night) and patient groups (NMC, AMC, SMC) using RMSCE and RMSsEsurrogate

Joint evaluation of RMSCE and RMSsE over heart period and QT variabilities can help typify autonomic function and clarify differences between asymptomatic and symptomatic LQT1 patients.

Abstract

The study proposes the contemporaneous assessment of conditional entropy (CE) and self-entropy (sE), being the two terms of the Shannon entropy (ShE) decomposition, as a function of the time scale via refined multiscale CE (RMSCE) and sE (RMSsE) with the aim at gaining insight into cardiac control in long QT syndrome type 1 (LQT1) patients featuring the KCNQ1-A341V mutation. CE was estimated via the corrected CE (CCE) and sE as the difference between the ShE and CCE. RMSCE and RMSsE were computed over the beat-to-beat series of heart period (HP) and QT interval derived from 24-hour Holter electrocardiographic recordings during daytime (DAY) and nighttime (NIGHT). LQT1 patients were subdivided into asymptomatic and symptomatic mutation carriers (AMCs and SMCs) according to the severity of symptoms and contrasted with non-mutation carriers (NMCs). We found that RMSCE and RMSsE carry non-redundant information, separate experimental conditions (i.e., DAY and NIGHT) within a given group and distinguish groups (i.e., NMC, AMC and SMC) assigned the experimental condition. Findings stress the importance of the joint evaluation of RMSCE and RMSsE over HP and QT variabilities to typify the state of the autonomic function and contribute to clarify differences between AMCs and SMCs.

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