What is the clinical evidence from this study?

Study design: Cohort. Population: Lung cancer with brain metastases (n=56). Intervention: Low heart rate variability (RMSSD ≤ 4.8 ms) vs. Higher heart rate variability (RMSSD > 4.8 ms). Primary outcome: Overall survival (HR 3.457, 95% CI 1.303-9.171, p=0.013).

February 17, 2022Frontiers in Neuroscience8 citationsOpen Access

Low Heart Rate Variability Predicts Poor Overall Survival of Lung Cancer Patients With Brain Metastases

SWShuang Wu GLGuangqiao Li WGWeizheng Guan

Key Result

Decreased root mean square of successive differences (RMSSD ≤ 4.8 ms) was independently associated with shorter overall survival in lung cancer patients with brain metastases (HR 3.457).

Study Design

Type

Cohort (n=56)

Multicenter

Structured PICO

Does heart rate variability predict overall survival in lung cancer patients with brain metastases?

Population

56 patients with lung cancer and brain metastases receiving first-time radiotherapy, followed for a median of 9.3 months.

Exposure

Heart rate variability (HRV) assessment via 5-minute ECG before first brain radiotherapy

Outcome

Overall survival (from date of HRV testing to date of death or last follow-up)hard clinical

Decreased heart rate variability, specifically RMSSD, serves as an independent predictor of shorter survival in lung cancer patients with brain metastases.

Main Result

Hazard Ratio: 3.457 (95% CI 1.303–9.171)

Absolute Event Rate: 2.6% vs 11.7%

p-value: p=0.013

Limitations

Small sample size with 42.9% of patients still alive at the end of the study, requiring longer follow-up
Heterogeneity in radiotherapy modality and dose
Number of brain metastases was unclear in some patients, preventing the use of GPA as a prognostic index

Abstract

BACKGROUND: The aim of this prospective study was to evaluate the association between heart rate variability (HRV) and overall survival of lung cancer patients with brain metastases (LCBM). METHODS: Fifty-six LCBM patients were enrolled in this study. Five-minute electrocardiograms were collected before the time to first brain radiotherapy. HRV was analyzed quantitatively by using the time domain parameters, i.e., the standard deviation of all normal-normal intervals (SDNN) and the root mean square of successive differences (RMSSD). Survival time for LCBM patients was defined as from the date of HRV testing to the date of death or the last follow-up. RESULTS: = 0.013, hazard ratio = 3.457, 95% confidence interval = 1.303-9.171) was also an independent negative prognostic factor after adjusting for mean heart rate, Karnofsky performance status, and number of brain metastases in LCBM patients. CONCLUSION: Decreased RMSSD is independently associated with shorter survival time in LCBM patients. HRV might be a novel predictive biomarker for LCBM prognosis.

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