Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel.
Department of Emergency Medicine, Rambam Health Care Campus, Haifa, Israel.
PLoS One. 2023 Jun 23;18(6):e0287607. doi: 10.1371/journal.pone.0287607. eCollection 2023.
Infective endocarditis (IE) is a disease that poses a serious health risk. It is important to identify high-risk patients early in the course of their treatment. In the current study, we evaluated the prognostic value of ultra-short heart-rate variability (HRV), an index of vagal nerve activity, in IE.
Retrospective analysis was performed on adult patients admitted to a tertiary hospital due to IE. A logistic regression (LR) was used to determine whether clinical, laboratory, and HRV parameters were predictive of specific clinical features (valve type, staphylococcal infection) or severe short-term complications (cardiac, metastatic infection, and death). The accuracy of the model was evaluated through the measurement of the area under the curve (AUC) of the receiver operating characteristic curve (ROC). An analysis of survival was conducted using Cox regression. A number of HRV indices were calculated, including the standard deviation of normal heart-beat intervals (SDNN) and the root mean square of successive differences (RMSSD).
75 patients, aged 60.3(±18.6) years old, were examined. When compared with published age- and gender-adjusted HRV norms, SDNN and RMSSD were found to be relatively low in our cohort (75%-76% lower than the median; 33%-41% lower than the 2nd percentile). 26(34.6%) patients developed a metastatic infection, with RMSSD<7.03ms (adjusted odds ratio (aOR) 9.340, p = 0.002), incorporated in a multivariate LR model (AUC 0.833). Furthermore, 27(36.0%) patients were diagnosed with Staphylococcus IE, with SDNN<4.92ms (aOR 5.235, p = 0.004), a major component of the multivariate LR model (AUC 0.741). Multivariate Cox regression survival model, included RMSSD (HR 1.008, p = 0.012).
SDNN, and particularly RMSSD, derived from ultra-short ECG recordings, may provide prognostic information about patients presenting with IE.
感染性心内膜炎（IE）是一种严重的健康风险疾病。重要的是要在治疗过程中尽早识别高危患者。在目前的研究中，我们评估了超短心率变异性（HRV），即迷走神经活动指标，在 IE 中的预后价值。
对因 IE 入住三级医院的成年患者进行回顾性分析。使用逻辑回归（LR）确定临床、实验室和 HRV 参数是否可预测特定的临床特征（瓣膜类型、葡萄球菌感染）或严重的短期并发症（心脏、转移性感染和死亡）。通过接收者操作特征曲线（ROC）的曲线下面积（AUC）测量评估模型的准确性。使用 Cox 回归进行生存分析。计算了多项 HRV 指数，包括正常心跳间隔的标准差（SDNN）和连续差值的均方根（RMSSD）。
共检查了 75 名年龄 60.3(±18.6)岁的患者。与发表的年龄和性别调整后的 HRV 正常值相比，我们队列中的 SDNN 和 RMSSD 相对较低（中位数低 75%-76%；第 2 百分位低 33%-41%）。26(34.6%)例患者发生转移性感染，RMSSD<7.03ms（调整后优势比（aOR）9.340，p=0.002），纳入多变量 LR 模型（AUC 0.833）。此外，27(36.0%)例患者被诊断为金黄色葡萄球菌 IE，SDNN<4.92ms（aOR 5.235，p=0.004），是多变量 LR 模型的主要组成部分（AUC 0.741）。多变量 Cox 回归生存模型，包括 RMSSD（HR 1.008，p=0.012）。
从超短 ECG 记录中得出的 SDNN，特别是 RMSSD，可能为患有 IE 的患者提供预后信息。
