Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.
Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.
J Cardiol. 2020 Dec;76(6):542-548. doi: 10.1016/j.jjcc.2020.05.017. Epub 2020 Jul 4.
A discordant biological clock could potentially induce sudden cardiac death (SCD). We aimed to evaluate the circadian change of heart rate variability (HRV) and its relationship to the risks of ventricular arrhythmia (VA) and near syncope in patients with chronic kidney disease (CKD).
In this retrospective study, non-CKD and CKD patients were enrolled and underwent a 24-hour Holter examination for linear and nonlinear HRV analyses. The multiscale entropy (MSE) method was selected for nonlinear HRV analyses. The documented VAs or episodes of near syncope were classified as high-risk SCD group (n=8) and others as low-risk SCD group (n=21).
In linear analyses, time and frequency domains revealed no significant difference between groups. In nonlinear analyses with MSE, MSE, MSE, and MSE were significantly lower (p=0.002, p<0.0001, and p=0.013) in the high-risk SCD group, compared to those in the low-risk SCD group, respectively. Comparing between daytime and nighttime within each group, the MSE revealed no difference in the high-risk SCD group (p=0.128), whereas the daytime was significantly higher in the low-risk SCD group (p=0.048). The area under the curve (AUC) analysis revealed MSE has the best predictive power associated with VAs and near syncope with a cut-off value of ≤24.64 (p<0.001).
Nonlinear analysis with MSE demonstrated the loss of circadian change in CKD patients and was associated with a higher risk for VAs and near syncope. The MSE method demonstrated the diurnal change of rhythm dynamics which identifies potential autonomic dysfunction leading to poor prognosis.
不规律的生物钟可能会导致心源性猝死（SCD）。我们旨在评估心率变异性（HRV）的昼夜变化及其与慢性肾脏病（CKD）患者室性心律失常（VA）和近乎晕厥风险的关系。
在这项回顾性研究中，招募了非 CKD 和 CKD 患者，并进行了 24 小时动态心电图检查以进行线性和非线性 HRV 分析。多尺度熵（MSE）方法用于非线性 HRV 分析。记录的 VA 或近乎晕厥发作被分类为高危 SCD 组（n=8）和其他为低危 SCD 组（n=21）。
在线性分析中，时域和频域分析在两组之间没有显著差异。在使用 MSE 的非线性分析中，MSE、MSE、MSE 和 MSE 分别明显低于（p=0.002、p<0.0001 和 p=0.013）高危 SCD 组，与低危 SCD 组相比。在每组内比较白天和夜间，高危 SCD 组的 MSE 没有差异（p=0.128），而低危 SCD 组的白天明显更高（p=0.048）。曲线下面积（AUC）分析显示，MSE 与 VA 和近乎晕厥相关，具有最佳的预测能力，截断值为≤24.64（p<0.001）。
MSE 的非线性分析显示 CKD 患者的昼夜节律变化丧失，与 VA 和近乎晕厥的风险增加相关。MSE 方法显示了节律动力学的昼夜变化，可识别潜在的自主神经功能障碍，导致预后不良。
