Heart Rhythm Complexity Predicts Long-Term Cardiovascular Outcomes in Peritoneal Dialysis Patients: A Prospective Cohort Study
Journal
Journal of the American Heart Association
Journal Volume
9
Journal Issue
2
Pages
e013036
Date Issued
2020
Author(s)
Chen Lin
Hsi-Pin Ma
Men-Tzung Lo
Chih-Ting Lin
Chung-Kang Peng
Abstract
Background: Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. Heart rhythm complexity analysis has been shown to be useful in predicting outcomes in various diseases; however, data on patients with end-stage renal disease are limited. In this study, we analyzed the association between heart rhythm complexity and long-term cardiovascular outcomes in patients with end-stage renal disease receiving peritoneal dialysis. Methods and Results: We prospectively enrolled 133 patients receiving peritoneal dialysis and analyzed linear heart rate variability and heart rhythm complexity variables including detrended fluctuation analysis (DFA) and multiscale entropy. The primary outcome was cardiovascular mortality, and the secondary outcome was the occurrence of major adverse cardiovascular events. After a median of 6.37?years of follow-up, 21 patients (22%) died from cardiovascular causes. These patients had a significantly lower low-frequency band of heart rate variability, low/high-frequency band ratio, total power band of heart rate variability, heart rate turbulence slope, deceleration capacity, short-term DFA (DFAα1); and multiscale entropy slopes 1 to 5, scale 5, area 1 to 5, and area 6 to 20 compared with the patients who did not die from cardiovascular causes. Time-dependent receiver operating characteristic curve analysis showed that DFAα1 had the greatest discriminatory power for cardiovascular mortality (area under the curve: 0.763) and major adverse cardiovascular events (area under the curve: 0.730). The best cutoff value for DFAα1 was 0.98 to predict both cardiovascular mortality and major adverse cardiovascular events. Multivariate Cox regression analysis showed that DFAα1 (hazard ratio: 0.076; 95% CI, 0.016–0.366; P=0.001) and area 1 to 5 (hazard ratio: 0.645; 95% CI, 0.447–0.930; P=0.019) were significantly associated with cardiovascular mortality. Conclusions: Heart rhythm complexity appears to be a promising noninvasive tool to predict long-term cardiovascular outcomes in patients receiving peritoneal dialysis. ? 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
SDGs
Other Subjects
adult; Article; cardiovascular disease; cardiovascular mortality; cardiovascular system examination; clinical outcome; cohort analysis; controlled study; detrended fluctuation analysis; end stage renal disease; female; follow up; hazard ratio; heart rate variability; heart rhythm; hemodialysis patient; human; long term care; major clinical study; male; multiscale entropy; peritoneal dialysis; prediction; priority journal; proportional hazards model; prospective study; receiver operating characteristic; adverse event; aged; ambulatory electrocardiography; cardiovascular disease; chronic kidney failure; complication; heart rate; middle aged; mortality; pathophysiology; peritoneal dialysis; predictive value; risk assessment; risk factor; time factor; treatment outcome; Adult; Aged; Cardiovascular Diseases; Electrocardiography, Ambulatory; Female; Heart Rate; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Predictive Value of Tests; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
Publisher
American Heart Association Inc.
Type
journal article