Margret and H. A. Rey Institute for Nonlinear Dynamics in Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts.
Am J Physiol Heart Circ Physiol. 2021 Jan 1;320(1):H256-H271. doi: 10.1152/ajpheart.00421.2020. Epub 2020 Sep 28.
Heart rate fragmentation (HRF), a marker of abnormal sinoatrial dynamics, was shown to be associated with incident cardiovascular events in the Multi-Ethnic Study of Atherosclerosis (MESA). Here, we test the hypothesis that HRF is also associated with incident atrial fibrillation (AF) in the MESA cohort of participants who underwent in-home polysomnography (PSG) and in two high-risk subgroups: those ≥70 yr taking antihypertensive medication and those with serum concentrations of NH-terminal prohormone B-type natriuretic peptide (NT-proBNP) >125 pg/ml (top quartile). Heart rate time series ( = 1,858) derived from the ECG channel of the PSG were analyzed using newly developed HRF metrics, traditional heart rate variability (HRV) indices and two widely used nonlinear measures. Eighty-three participants developed AF over a mean follow-up period of 3.83 ± 0.87 yr. A one-standard deviation increase in HRF was associated with a 31% (95% CI: 3-66%) increase in risk of incident AF, in Cox models adjusted for age, height, NT-proBNP, and frequent premature supraventricular complexes. Furthermore, HRF added value to the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)-AF models. Traditional HRV and nonlinear indices were not significantly associated with incident AF. In the two high-risk subgroups defined above, HRF was also significantly associated with incident AF in unadjusted and adjusted models. These findings support the translational utility of HRF metrics for short-term (∼4-yr) prediction of AF. In addition, they support broadening the concept of atrial remodeling to include electrodynamical remodeling, a term used to refer to pathophysiological alterations in sinus interbeat interval dynamics. This study is the first demonstration that heart rate fragmentation (HRF), a marker of anomalous sinoatrial dynamics, is an independent predictor of atrial fibrillation (AF). Traditional measures of heart rate variability and two widely used nonlinear measures were not associated with incident AF in the Multi-Ethnic Study of Atherosclerosis. Fragmentation measures added value to the strongest contemporary predictors of AF, including ECG-derived parameters, coronary calcification score, serum concentrations of NH-terminal prohormone B-type natriuretic peptide, and supraventricular ectopy. The computational algorithms for quantification of HRF could be readily incorporated into wearable ECG monitoring devices.
心率碎裂(HRF)是一种异常窦房结动力学的标志物,在动脉粥样硬化多民族研究(MESA)中显示与心血管事件的发生有关。在这里,我们检验了这样一个假设,即 HRF 也与接受家庭多导睡眠图(PSG)检查的 MESA 队列中的心房颤动(AF)事件有关,同时也在两个高危亚组中进行了检验:服用抗高血压药物且血清 N 末端脑利钠肽前体(NT-proBNP)浓度>125 pg/ml(四分位上限)的参与者≥70 岁。使用新开发的 HRF 指标、传统心率变异性(HRV)指标和两种广泛使用的非线性指标,分析来自 PSG 心电图通道的心率时间序列(=1858)。在平均 3.83±0.87 年的随访期间,有 83 名参与者发生了 AF。在 Cox 模型中,经年龄、身高、NT-proBNP 和频发室上性早搏校正后,HRF 每增加一个标准差,发生 AF 的风险增加 31%(95%CI:3-66%)。此外,HRF 增加了 Cohorts for Heart and Aging Research in Genomic Epidemiology(CHARGE)-AF 模型的预测价值。传统的 HRV 和非线性指标与 AF 的发生无显著相关性。在上述两个高危亚组中,在未经校正和校正模型中,HRF 与 AF 的发生也显著相关。这些发现支持 HRF 指标用于预测 AF 的短期(约 4 年)的转化应用。此外,它们还支持将心房重构的概念扩展到电动力学重构,这一术语用于指窦房结间间期动力学的病理生理改变。这项研究首次表明,心率碎裂(HRF)是一种异常窦房结动力学的标志物,是心房颤动(AF)的独立预测因子。在动脉粥样硬化多民族研究(MESA)中,传统的心率变异性指标和两种广泛使用的非线性指标与 AF 的发生均无相关性。碎裂指标增加了当代 AF 最强预测因子的预测价值,包括心电图衍生参数、冠状动脉钙化评分、血清 N 末端脑利钠肽前体浓度和室上性异位搏动。HRF 量化的计算算法可以很容易地整合到可穿戴的心电图监测设备中。