Abstract
BackgroundHeart rhythm complexity, a measure of heart rate dynamics and a risk predictor in various clinical diseases, has not been systematically studied in patients with end-stage renal disease. The aim of this study is to investigate the heart rhythm complexity and its prognostic value for mortality in end-stage renal disease patients undergoing hemodialysis.MethodsTo assess heart rhythm complexity and conventional heart rate variability measures, 4-h continuous electrocardiography for a retrospective cohort of 202 ostensibly healthy control subjects and 51 hemodialysis patients with end-stage renal disease were analyzed. Heart rhythm complexity was quantified by the complexity index from the measurement of the multiscale entropy profile.ResultsDuring a follow-up of 13 months, 8 people died in the patient group. Values of either traditional heart rate variability measurements or complexity indices were found significantly lower in patients than those in healthy controls. In addition, the complexity indices (Area 1–5, Area 6–15 and Area 6–20) in the mortality group were significantly lower than those in the survival group, while there were no significant differences in traditional heart rate variability parameters between the two groups. In receiver operating characteristic curve analysis, Area 6–20 (AUC = 0.895, p < 0.001) showed the strongest predictive power between mortality and survival groups.ConclusionThe results suggest that heart rhythm complexity is impaired for patients with end-stage renal disease. Furthermore, the complexity index of heart rate variability quantified by multiscale entropy may be a powerful independent predictor of mortality in end-stage renal disease patients undergoing hemodialysis.
Highlights
Heart rhythm complexity, a measure of heart rate dynamics and a risk predictor in various clinical diseases, has not been systematically studied in patients with end-stage renal disease
Several previous studies have used heart rate variability (HRV) parameters based on traditional linear HRV analysis to predict patient outcomes and found that lower HRV is related to an increased risk of cardiovascular and all-cause mortality in patients with End-stage renal disease (ESRD) receiving chronic hemodialysis [9,10,11,12,13]
Consistent with previous studies [10, 31,32,33], lowered HRV metrics and complexity index (CI) were observed in our study, which confirms that ESRD patients have impaired vagal control or cardiac autonomic function as well as heart rhythm complexity caused by disease pathology
Summary
A measure of heart rate dynamics and a risk predictor in various clinical diseases, has not been systematically studied in patients with end-stage renal disease. The aim of this study is to investigate the heart rhythm complexity and its prognostic value for mortality in end-stage renal disease patients undergoing hemodialysis. Several previous studies have used HRV parameters based on traditional linear HRV analysis to predict patient outcomes and found that lower HRV is related to an increased risk of cardiovascular and all-cause mortality in patients with ESRD receiving chronic hemodialysis [9,10,11,12,13]. The aim of the present study was to investigate the heart rate complexity derived from MSE analysis of long-term electrocardiograms (ECG) and its prognostic value for all-cause mortality in patients with ESRD receiving hemodialysis therapy
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