Abstract
Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1–5) and 6 to 20 (area 6–20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function.
Highlights
To traditional HRV parameters based on linear methodology, heart rhythm complexity analysis has been shown to have a better predictive power for prognosis in patients with cardiovascular disease[16,17]
Since renal impairment might have direct or indirect effect on autonomic nervous system, in this study, we plan to enroll a group of end-stage renal disease (ESRD) patients without cardiovascular disease and a group of subjects with normal renal function to evaluate the direct effect of ESRD on heart rhythm complexity
ESRD is characterized by a high prevalence of sudden cardiac death and autonomic nervous system dysfunction including parasympathetic damage and sympathetic nerve overactivity[3,4,5]
Summary
To traditional HRV parameters based on linear methodology, heart rhythm complexity analysis has been shown to have a better predictive power for prognosis in patients with cardiovascular disease[16,17]. Few studies evaluate heart rhythm complexity in ESRD patients[18,19,20]. All these studies have used DFA or approximate entropy anaylsis to derive heart rhythm complexity[19,20]. No study has reported the results of MSE analysis in ESRD patients. Most of the studies evaluate the prognostic prediction in ESRD patients without enrolling control groups. Since renal impairment might have direct or indirect effect (through cardiovascular disease) on autonomic nervous system, in this study, we plan to enroll a group of ESRD patients without cardiovascular disease and a group of subjects with normal renal function to evaluate the direct effect of ESRD on heart rhythm complexity
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