Two nonlinear heart rate variability variables (from empirical mode decomposition and symbolic dynamics) added independent prognostic information to a clinical model for cardiac death or urgent transplant.
Cohort (n=200)
Do nonlinear indices of heart rate variability add independent prognostic value for predicting cardiac death or urgent transplantation in stable chronic heart failure patients?
Nonlinear indices of heart rate variability, specifically from empirical mode decomposition and symbolic dynamics, provide independent prognostic value beyond standard clinical risk factors in stable heart failure patients.
AIMS: We aimed to assess the mutual interrelationships and to compare the prognostic value of a comprehensive set of nonlinear indices of heart rate variability (HRV) in a population of chronic heart failure (CHF) patients. METHODS AND RESULTS: Twenty nonlinear HRV indices, representative of symbolic dynamics, entropy, fractality-multifractality, predictability, empirical mode decomposition, and Poincaré plot families, were computed from 24-hour Holter recordings in 200 stable CHF patients in sinus rhythm (median age interquartile range: 54 47-58 years, LVEF: 23 19-28%, NYHA class II-III: 88%). End point for survival analysis (Cox model) was cardiac death or urgent transplantation. Homogeneous variables were grouped by cluster analysis, and in each cluster redundant variables were discarded. A prognostic model including only known clinical and functional risk factors was built and the ability of each selected HRV variable to add prognostic information to this model assessed. Bootstrap resampling was used to test the models stability. Four nonlinear variables showed a correlation >0.90 with classical linear ones and were discarded. Correlations >0.80 were found between several nonlinear variables. Twelve clusters were obtained and from each cluster a candidate predictor was selected. Only two variables (from empirical mode decomposition and symbolic dynamics families) added prognostic information to the clinical model. CONCLUSION: This exploratory study provides evidence that, despite some redundancies in the informative content of nonlinear indices and strong differences in their prognostic power, quantification of nonlinear properties of HRV provides independent information in risk stratification of CHF patients.
Maestri et al. (Tue,) conducted a cohort in chronic heart failure (n=200). Nonlinear indices of heart rate variability vs. Clinical risk factors and linear HRV indices was evaluated on Cardiac death or urgent transplantation. Two nonlinear heart rate variability variables (from empirical mode decomposition and symbolic dynamics) added independent prognostic information to a clinical model for cardiac death or urgent transplant.