Abstract
Analysis of heart failure is important in clinical practice to ensure coronary artery disease (CAD) patients will be provided with appropriate timely treatment. The current gold-standard, echocardiography, although reliable, provides a once-off left ventricular ejection fraction (LVEF) measurement and does not provide information about heart function disturbances during day/night cardiac cycles. Additionally, the discrimination between heart failure with preserved and mid-range ejection fraction remains challenging in echocardiography tests. In this vein, this study was sought to investigate the ability of heart rate variability (HRV) in categorizing CAD patients into multiple LVEF groups throughout the 24-hour circadian cycle and checking its agreement with established gold-standard echocardiography-based guidelines. A total of 92 CAD patients who have suffered from heart failure were included in this study. The newly introduced index, HRV ejection fraction (HRVEF), was based on optimizing indices extracted from HRV data, which are correlated with the sympathetic and parasympathetic nervous systems, to form group membership of the preserved (HFpEF), mid-range (HFmEF), and reduced (HFrEF) LVEF categories. HRVEF groups optimized on hourly basis through Jenks natural breaks algorithm exhibited a consistent pattern with a goodness of variance fit (GVF) of more than 70% accuracy during the late-night to early-morning (01:00-08:00) and evening (17:00-23:00) time periods. At these hours, several HRV indices were found significant (p-value ≤0.05) in differentiating between HRVEF groups using statistical analysis of variance (ANOVA) test. These features include the successive differences between normal heartbeats (RMSSD), low and high frequency (LF, HF) power, standard deviation of normal heartbeats (SD2), short-term scaling exponent (alpha1), and percentage of normal heartbeats in alternation segments (PAS). The findings of this study suggest HRV as a promising supplementary tool to the once-off echocardiography for timely LVEF measurements and heart failure prognosis. It paves the way towards multi-time HRV-based estimations for LVEF according to the association between LVEF and HRV indices to better demonstrate the circadian cardiac function at different LVEF levels in CAD patients.
Highlights
Heart failure is a chronic condition that is characterized by a damaged or weakened heart muscle that often leads to a reduction in the overall cardiac output [1]
DATASET AND PATIENTS ENROLLMENT The selected coronary artery disease (CAD) patients dataset was obtained from the Intercity Digital ECG Alliance (IDEAL) study of the University of Rochester Medical Center Telemetric and Holter ECG Warehouse (THEW) archives [25]
This study demonstrated a strong association between Left ventricular ejection fraction (LVEF) and heart rate variability (HRV) during specific time periods in the circadian cardiac rhythm
Summary
Heart failure is a chronic condition that is characterized by a damaged or weakened heart muscle that often leads to a reduction in the overall cardiac output [1]. It is estimated that more than 26 million people are suffering from heart failure [2]. Diagnosis as well as timely medication help people to live a relatively normal life [3]. Left ventricular ejection fraction (LVEF) is the main clinical indicator used in the early diagnosis of heart failure.
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