Key result
Adjusting the amplitude of cyclic variation of heart rate for sleep apnea severity (percentile Acv) significantly improved post-AMI mortality risk prediction compared to unadjusted Acv, with a continuous net reclassification improvement of 0.90.
Why the study?
The authors investigated whether the predictive power of cyclic variation of heart rate amplitude (Acv) for post-AMI mortality could be improved by considering the effect of sleep apnea severity.
Does adjusting the amplitude of cyclic variation of heart rate for sleep apnea severity improve the prediction of all-cause mortality in post-AMI patients?
Cohort (n=717)
Yes
Does adjusting the amplitude of cyclic variation of heart rate for sleep apnea severity improve the prediction of all-cause mortality in post-AMI patients?
Adjusting the amplitude of cyclic variation of heart rate for sleep apnea severity significantly improves Holter ECG-based mortality risk stratification in patients following an acute myocardial infarction.
Adjusted Acv may refine post-AMI Holter risk stratification; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: desaturation. We investigated whether Acv's predictive power for post-AMI mortality could be improved by considering the effect of sleep apnea severity. METHODS: In 24-hr ECG in 265,291 participants of the Allostatic State Mapping by Ambulatory ECG Repository project, sleep apnea severity was estimated by the frequency of CVHR (Fcv) measured by an automated algorithm for auto-correlated wave detection by adaptive threshold (ACAT). The distribution of Acv on the Acv-Fcv relation map was modeled by percentile regression, and a function converting Acv into percentile value was developed. In the retrospective cohort of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study, consisting of 673 survivors and 44 non-survivors after AMI, the mortality predictive power of percentile Acv calculated by the function was compared with that of unadjusted Acv. RESULTS: Among the ALLSTAR ECG data, low Acv values appeared more likely when Fcv was low. The logistic regression analysis for mortality in the ENRICHD cohort showed c-statistics of 0.667 (SE, 0.041), 0.817 (0.035), and 0.843 (0.030) for Fcv, unadjusted Acv, and the percentile Acv, respectively. Compared with unadjusted Acv, the percentile Acv showed a significant net reclassification improvement of 0.90 (95% CI, 0.51-1.42). CONCLUSIONS: The predictive power of Acv for post-AMI mortality is improved by considering its relation to sleep apnea severity estimated by Fcv.
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Hayano et al. (2021) conducted a cohort in Acute myocardial infarction (AMI) (n=717). Percentile amplitude of cyclic variation of heart rate (Acv) vs. Unadjusted Acv was evaluated on All-cause mortality (Continuous NRI 0.90, 95% CI 0.51-1.42). Adjusting the amplitude of cyclic variation of heart rate for sleep apnea severity (percentile Acv) significantly improved post-AMI mortality risk prediction compared to unadjusted Acv, with a continuous net reclassification improvement of 0.90.
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