Key result
CRT restores cardio-respiratory interactions, driven by respiratory sinus arrhythmia in responders.
Why the study?
In heart failure, the degree of cardio-respiratory coupling changes primarily depends on heart-rhythm alterations, but these directed interactions and the effects of cardiac resynchronization therapy required quantification using information-theoretic measures.
Does cardiac resynchronization therapy alter cardio-respiratory interactions in patients with heart failure?
Cohort (n=39)
No
Does cardiac resynchronization therapy alter cardio-respiratory interactions in patients with heart failure?
Information-theoretic analysis of cardio-respiratory interactions reveals non-linear coupling that is sensitive to ventricular extrasystoles and may serve as a potential marker for identifying future CRT responders.
The properties of cardio-respiratory coupling (CRC) are affected by various pathological conditions related to the cardiovascular and/or respiratory systems. In heart failure, one of the most common cardiac pathological conditions, the degree of CRC changes primarily depend on the type of heart-rhythm alterations. In this work, we investigated CRC in heart-failure patients, applying measures from information theory, i.e., Granger Causality (GC), Transfer Entropy (TE) and Cross Entropy (CE), to quantify the directed coupling and causality between cardiac (RR interval) and respiratory (Resp) time series. Patients were divided into three groups depending on their heart rhythm (sinus rhythm and presence of low/high number of ventricular extrasystoles) and were studied also after cardiac resynchronization therapy (CRT), distinguishing responders and non-responders to the therapy. The information-theoretic analysis of bidirectional cardio-respiratory interactions in HF patients revealed the strong effect of nonlinear components in the RR (high number of ventricular extrasystoles) and in the Resp time series (respiratory sinus arrhythmia) as well as in their causal interactions. We showed that GC as a linear model measure is not sensitive to both nonlinear components and only model free measures as TE and CE may quantify them. CRT responders mainly exhibit unchanged asymmetry in the TE values, with statistically significant dominance of the information flow from Resp to RR over the opposite flow from RR to Resp, before and after CRT. In non-responders this asymmetry was statistically significant only after CRT. Our results indicate that the success of CRT is related to corresponding information transfer between the cardiac and respiratory signal quantified at baseline measurements, which could contribute to a better selection of patients for this type of therapy.
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Platiša et al. (2023) conducted a cohort in Heart Failure (n=39). Cardiac Resynchronization Therapy (CRT) vs. Baseline (pre-implantation) was evaluated on Cardio-respiratory coupling (assessed by Transfer Entropy, Granger Causality, and Cross Entropy). Cardiac resynchronization therapy restored cardio-respiratory interactions, particularly the respiratory sinus arrhythmia component, with CRT responders exhibiting statistically significant dominance of information flow from respiration to heart rate.
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