Abstract
Pulmonary hypertension (PH) is a fatal disease—even with state-of-the-art medical treatment. Non-invasive clinical tools for risk stratification are still lacking. The aim of this study was to investigate the clinical utility of heart rhythm complexity in risk stratification for PH patients. We prospectively enrolled 54 PH patients, including 20 high-risk patients (group A; defined as WHO functional class IV or class III with severely compromised hemodynamics), and 34 low-risk patients (group B). Both linear and non-linear heart rate variability (HRV) variables, including detrended fluctuation analysis (DFA) and multiscale entropy (MSE), were analyzed. In linear and non-linear HRV analysis, low frequency and high frequency ratio, DFAα1, MSE slope 5, scale 5, and area 6–20 were significantly lower in group A. Among all HRV variables, MSE scale 5 (AUC: 0.758) had the best predictive power to discriminate the two groups. In multivariable analysis, MSE scale 5 (p = 0.010) was the only significantly predictor of severe PH in all HRV variables. In conclusion, the patients with severe PH had worse heart rhythm complexity. MSE parameters, especially scale 5, can help to identify high-risk PH patients.
Highlights
Pulmonary hypertension (PH) is a progressive, complex, and fatal disease
The pulmonary arterial hypertension (PAH) was in the World Health Organization (WHO) group 1 and chronic thromboembolic pulmonary hypertension (CTEPH) was in the WHO group 4
Adding heart rhythm complexity predictors to traditional linear heart rate variability (HRV) parameters improved the power to predict high-risk PH patients. This is the first study to demonstrate an association between heart rhythm complexity and severity of PH, and the better performance of heart rhythm complexity in identifying high-risk PH patients than traditional HRV parameters
Summary
Pulmonary hypertension (PH) is a progressive, complex, and fatal disease. It involves heterogenous etiologies and different mechanisms [1], and eventually leads to right heart failure. The mortality of PH patients is high even after contemporary treatment [2]; timely and intensive management can improve outcomes even in high-risk patients. The dynamic adjustment of PH medications, based on disease status during followup, plays an important role in PH management [3,4,5]. A useful tool for PH risk stratification is urgently needed to guide PH treatment. Several prognostic factors of PH have been verified, including sex, exercise tolerance, right heart hemodynamics, and functional performance [6,7,8], and they have been applied in different prediction models
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