Key result
Patients with pulmonary hypertension had significantly impaired heart rhythm complexity, with multiscale entropy scale 5 demonstrating excellent discriminatory power to predict the disease (AUC 0.845, p<0.001).
Why the study?
Pulmonary hypertension is fatal and lacks reliable prognostic tools, and heart rhythm complexity had not previously been studied in this population.
Does heart rhythm complexity analysis improve the prediction of pulmonary hypertension compared to traditional HRV parameters?
Case-Control (n=114)
No
Does heart rhythm complexity analysis improve the prediction of pulmonary hypertension compared to traditional HRV parameters?
Odds Ratio: 0.004 (95% CI 0.001–0.037)
Absolute Event Rate: 1.054% vs 1.436%
p-value: p=<0.001
Heart rhythm complexity parameters, particularly MSE scale 5, demonstrate excellent discriminatory power for detecting pulmonary hypertension and significantly improve upon traditional linear HRV parameters.
Pulmonary hypertension is a fatal disease, however reliable prognostic tools are lacking. Heart rhythm complexity analysis is derived from non-linear heart rate variability (HRV) analysis and has shown excellent performance in predicting clinical outcomes in several cardiovascular diseases. However, heart rhythm complexity has not previously been studied in pulmonary hypertension patients. We prospectively analyzed 57 patients with pulmonary hypertension (31 with pulmonary arterial hypertension and 26 with chronic thromboembolic pulmonary hypertension) and compared them to 57 age- and sex-matched control subjects. Heart rhythm complexity including detrended fluctuation analysis (DFA) and multiscale entropy (MSE) and linear HRV parameters were analyzed. The patients with pulmonary hypertension had significantly lower mean RR, SDRR, pNN 20 , VLF, LF, LF/HF ratio, DFAα1, MSE slope 5, scale 5, area 1–5 and area 6–20 compared to the controls. Receiver operating characteristic curve analysis showed that heart rhythm complexity parameters were better than traditional HRV parameters to predict pulmonary hypertension. Among all parameters, scale 5 had the greatest power to differentiate the pulmonary hypertension patients from controls (AUC: 0.845, P < 0.001). Furthermore, adding heart rhythm complexity parameters significantly improved the discriminatory power of the traditional HRV parameters in both net reclassification improvement and integrated discrimination improvement models. In conclusion, the patients with pulmonary hypertension had worse heart rhythm complexity. MSE parameters, especially scale 5, had excellent single discriminatory power to predict whether or not patients had pulmonary hypertension.
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Tsai et al. (2019) conducted a case-control in Pulmonary Hypertension (n=114). Pulmonary hypertension vs. Age- and sex-matched controls without pulmonary hypertension was evaluated on Multiscale entropy (MSE) scale 5 (OR 0.004, 95% CI <0.001-0.037, p=<0.001). Patients with pulmonary hypertension had significantly impaired heart rhythm complexity, with multiscale entropy scale 5 demonstrating excellent discriminatory power to predict the disease (AUC 0.845, p<0.001).
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