Key result
A low heart rhythm complexity index (Area 6-20 < 13.43) was associated with a significantly higher risk of all-cause mortality in patients with end-stage renal disease undergoing hemodialysis (HR 13.61).
Why the study?
Heart rhythm complexity has not been systematically studied in patients with end-stage renal disease.
Cohort (n=102)
No
Hazard Ratio: 13.61 (95% CI 2.74–67.77)
Absolute Event Rate: 66.7% vs 4.8%
Heart rhythm complexity quantified by multiscale entropy (specifically Area 6-20) is a strong, independent predictor of all-cause mortality in patients with end-stage renal disease undergoing hemodialysis.
May aid mortality risk stratification in hemodialysis patients; hypothesis-generating and requires prospective validation before clinical adoption.
Objective Heart rhythm complexity, a measure of heart rate dynamics and a risk predictor in various clinical diseases, has not been systematically studied in patients with end-stage renal disease. The aim of this study is to investigate the heart rhythm complexity and its prognostic value for mortality in end-stage renal disease patients undergoing hemodialysis.Methods To assess heart rhythm complexity and conventional heart rate variability measures, 4-hour continuous electrocardiography for a retrospective cohort of 202 ostensibly healthy control subjects and 51 hemodialysis patients with end-stage renal disease were analyzed. Heart rhythm complexity was quantified by the complexity index from the measurement of the multiscale entropy profile.Results During a median follow-up of 13 months, 8 people died in the patient group. Values of either traditional heart rate variability measurements or complexity indices were found significantly lower in patients than those in healthy controls. In addition, the complexity indices (Area 1-5, Area 6-15 and Area 6-20) in the mortality group were significantly lower than those in the survival group, while there were no significant differences in traditional heart rate variability parameters between the two groups. In receiver operating characteristic curve analysis, Area 6-20 (AUC = 0.895, p<0.001) showed the strongest predictive power between mortality and survival groups.Conclusion The results suggest that heart rhythm complexity is impaired for patients with end-stage renal disease. Furthermore, the complexity index of heart rate variability quantified by multiscale entropy may be a powerful independent predictor of mortality in end-stage renal disease patients undergoing hemodialysis.
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Liu et al. (2020) conducted a cohort in End-Stage Renal Disease (ESRD) (n=102). Low heart rhythm complexity (Area 6-20 < 13.43) vs. High heart rhythm complexity (Area 6-20 ≥ 13.43) was evaluated on All-cause mortality (HR 13.61, 95% CI 2.74-67.77). A low heart rhythm complexity index (Area 6-20 < 13.43) was associated with a significantly higher risk of all-cause mortality in patients with end-stage renal disease undergoing hemodialysis (HR 13.61).
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