Abstract
Accurate measurements of autonomic nerve regulation in heart failure (HF) were unresolved. The discriminating performance of deceleration and acceleration capacities of heart rate in HF was evaluated in 130 HF patients and 212 controls. Acceleration capacity and deceleration capacity were independent risk factors for HF in males, evaluated by multiple logistic regression analysis, with odds ratios (ORs) of 5.94 and 0.13, respectively. Acceleration capacity was also an independent risk factor for HF in females, with an OR of 8.58. Deceleration capacity was the best cardiac electrophysiological index to classify HF in males, with an area under the receiver operating characteristic curve (AUC) of 0.88. Deceleration capacity was the best classification factor of HF in females with an AUC of 0.97, significantly higher than even left ventricular ejection fraction (LVEF). Acceleration capacity also showed high performance in classifying HF in males (0.84) and females (0.92). The cut-off values of deceleration capacity for HF classification in males and females were 4.55 ms and 4.85 ms, respectively. The cut-off values of acceleration capacity for HF classification in males and females were −6.15 ms and −5.75 ms, respectively. Our study illustrates the role of acceleration and deceleration capacity measurements in the neuro-pathophysiology of HF.
Highlights
IntroductionEvidence for an association between a propensity for lethal arrhythmias and signs of increased sympathetic or reduced vagal activity is abundant, the significance of the many different HRV indexes is more complex than generally appreciated, and there is potential for incorrect conclusions and for excessive or unfounded extrapolations[12]
Age, LAd, LVEDd, LVESd, QRS duration, QTc interval, ST amplitude, percentages with premature atrial contraction, atrial fibrillation, premature ventricular contraction and ventricular tachycardia, average heart rate, slowest heart rate, RMSSD, PNN50, and acceleration capacity were significantly higher in the Heart failure (HF) patients than controls (Table 1)
The left ventricular ejection fraction (LVEF), fastest heart rate, standard deviation of RR intervals (SDNN), high frequency (hF), low frequency (lF), very low frequency (vlF), triangle index, and deceleration capacity were significantly lower in the HF patients than controls (Table 1)
Summary
Evidence for an association between a propensity for lethal arrhythmias and signs of increased sympathetic or reduced vagal activity is abundant, the significance of the many different HRV indexes is more complex than generally appreciated, and there is potential for incorrect conclusions and for excessive or unfounded extrapolations[12]. In 2006, Baver et al established an approach to distinguish between vagal and sympathetic nervous system roles that affect cardiac electrophysiology using a signal processing algorithm to separately characterize the deceleration and acceleration capacities of the heart rate[14]. Their report advanced cardiac electrophysiological analysis and provided a new approach to quantify the effects of the vagal and sympathetic nervous systems on heart physiology. The significance of acceleration capacity and deceleration in HF was evaluated comprehensively by receiver operating characteristic (ROC) and multiple logistic regression analysis together with echocardiographic and HRV indexes under strict statistical quality control.
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