What is the clinical evidence from this study?

Study design: Cohort. Population: Systolic heart failure (n=40). Intervention: Multiscale entropy (MSE) Area 6-20 ≤ 21.2 vs. Multiscale entropy (MSE) Area 6-20 > 21.2. Primary outcome: Mortality or urgent heart transplantation (AUC 0.858, p=0.0014).

April 13, 2011Open Access

The Prognostic Value of Non-Linear Analysis of Heart Rate Variability in Patients with Congestive Heart Failure—A Pilot Study of Multiscale Entropy

YHYi‐Lwun HoNational Taiwan University Hospital CLChen LinFu Jen Catholic University YLYen‐Hung LinHung Yen University of Technology and Education

Key Result

An area under the multiscale entropy curve for scales 6 to 20 of ≤21.2 served as a significant predictor of mortality or heart transplantation in patients with systolic heart failure (p=0.0014).

Study Design

Type

Cohort (n=40)

Multicenter

Structured PICO

Does multiscale entropy (MSE) analysis of heart rate variability predict mortality or urgent heart transplantation in patients with systolic heart failure?

Population

40 patients with systolic heart failure (LVEF <45%) were followed for an average of 684 days to evaluate the prognostic value of multiscale entropy derived from 24-hour Holter ECGs.

Exposure

Multiscale entropy (MSE) analysis of 24-hour Holter electrocardiogram (specifically the area under the MSE curve for scale 6 to 20).

Outcome

Mortality or urgent heart transplantationhard clinical

Multiscale entropy analysis of heart rate variability, specifically the area under the curve for scales 6 to 20, is a significant predictor of mortality or urgent heart transplantation in patients with systolic heart failure.

Main Result

Effect estimate: AUC 0.858

p-value: p=0.0014

Limitations

Small sample size and no placebo-controlled group
ECG data were recorded in normal free-running conditions with possible confounding factors such as physical activities and different breathing patterns
Did not assess the features or level of noise for more detailed information
Parameters related to possible physiological mechanisms of MSE (e.g., baroreflex sensitivity, catecholamine levels) were not collected

Abstract

AIMS: The influences of nonstationarity and nonlinearity on heart rate time series can be mathematically qualified or quantified by multiscale entropy (MSE). The aim of this study is to investigate the prognostic value of parameters derived from MSE in the patients with systolic heart failure. METHODS AND RESULTS: Patients with systolic heart failure were enrolled in this study. One month after clinical condition being stable, 24-hour Holter electrocardiogram was recording. MSE as well as other standard parameters of heart rate variability (HRV) and detrended fluctuation analysis (DFA) were assessed. A total of 40 heart failure patients with a mea age of 56±16 years were enrolled and followed-up for 684±441 days. There were 25 patients receiving β-blockers treatment. During follow-up period, 6 patients died or received urgent heart transplantation. The short-term exponent of DFA and the slope of MSE between scale 1 to 5 were significantly different between patients with or without β-blockers (p = 0.014 and p = 0.028). Only the area under the MSE curve for scale 6 to 20 (Area(6-20)) showed the strongest predictive power between survival (n = 34) and mortality (n = 6) groups among all the parameters. The value of Area(6-20)21.2 served as a significant predictor of mortality or heart transplant (p = 0.0014). CONCLUSION: The area under the MSE curve for scale 6 to 20 is not relevant to β-blockers and could further warrant independent risk stratification for the prognosis of CHF patients.

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