Predictive Value of Heart Rate Variability Indexes for 2-year Prognosis of the Patients after Transcatheter Aortic Valve Replacement.

Abstract

To explore the prognostic value of the heart rate variability (HRV) index in the patients undergoing transcatheter aortic valve replacement (TAVR). A cohort study. Department of Cardiology, Subei people's Hospital, Yangzhou University, Yangzhou, Jiangsu Province, China, from April 2018 to April 2021. Patients with severe symptomatic aortic stenosis (AS), who were treated with TAVR, were enrolled. All the patients had completed a 24-hour ambulatory electrocardiogram (AECG), and detected HRV within one week before TAVR. All-time domain and frequency domain indexes were analysed. According to the standard deviation of NN intervals (SDNN), the patients were divided into the high HRV group (H-HRV), and the low HRV group (L-HRV). Postoperative cardiac function and major adverse cardiovascular events (MACEs) were observed on follow-up for 24 months. Compared with the H-HRV group, the L-HRV group had a lower preoperative left ventricular ejection fraction (LVEF) [49.0 (42.5, 60.0) vs. 59.5 (51.0, 62.3), p = 0.028] and higher preoperative cardiac troponin I (cTnI) [0.03(0.02, 0.10) vs. 0.02 (0.02, 0.02), p = 0.007]. The incidence of MACEs after TAVR in the L-HRV group was significantly higher than that in the H-HRV group (45.5% vs. 13.6%, p = 0.021). The results of the Kaplan-Meier survival curve also showed that the prognosis of the L-HRV group was worse than that of the H-HRV group (Log Rank = 4.975, p = 0.026). After adjusting for preoperative standard deviation of the average NN intervals (SDANN) or preoperative low-frequency (LF) domain / high-frequency (HF) domain (LF/HF), preoperative HRV still was an independent risk factor for MACEs in AS patients undergoing TAVR [HR 3.718, 95% CI (1.020, 13.548), p = 0.047]. The receiver operating characteristic (ROC) curve suggested that HRV <61.0ms may be a predictor of MACEs in AS patients undergoing TAVR. The sensitivity and specificity were 83.9% and 76.9%, respectively. Preoperative HRV had a good short-term predictive value in AS patients undergoing TAVR. Heart rate variability, Aortic stenosis, Transcatheter aortic valve replacement, Ambulatory electrocardiogram.