Device-evaluated autonomic nervous function for predicting ventricular arrhythmias and all-cause mortality in patients who underwent cardiac resynchronization therapy-defibrillator

被引:1
|
作者
Cheng, Chendi [1 ]
Jiang, Jiang [1 ]
Chen, Keping [1 ]
Hua, Wei [1 ]
Su, Yangang [2 ]
Xu, Wei [3 ]
Fan, Xiaohan [1 ]
Dai, Yan [1 ]
Zhang, Shu [1 ]
机构
[1] Fuwai Hosp, Chinese Acad Med Sci & Peking Union Med Coll, State Key Lab Cardiovasc Dis, Arrhythmia Ctr,Natl Ctr Cardiovasc Dis, Beijing, Peoples R China
[2] Fudan Univ, Zhongshan Hosp, Shanghai Inst Cardiovasc Dis, Cardiol, Shanghai, Peoples R China
[3] Nanjing Drum Tower Hosp, Dept Cardiol, Nanjing, Peoples R China
关键词
Heart rate variability (HRV); autonomic nervous system (ANS); cardiac resychronization therapy-defibrillator; ventricular tachiarrhythmias; remote home monitoring (RHM); heart rate (HR); HEART-RATE-VARIABILITY; PHYSICAL-ACTIVITY; PROGNOSTIC VALUE; FAILURE; DYSFUNCTION; DEATH;
D O I
10.3389/fphys.2023.1090038
中图分类号
Q4 [生理学];
学科分类号
071003 ;
摘要
Introduction:Autonomic nervous system (ANS) function quantified by heart rate variability (HRV) was associated with long-term prognosis, but it was rarely used in the evaluation of patients with heart failure, especially those with cardiac resynchronization therapy-defibrillator (CRT-D) implantation. This study aimed to describe the changes in ANS function among patients who underwent CRT-D with remote home monitoring function, and explore predictive value of HRV for ventricular tachyarrhythmias (VTAs) and all-cause mortality. Method:Patients who underwent CRT-D implantation were included. Device-measured all-day HR, night-time HR, and HRV (measured by the standard deviation of the atrial-atrial sensed intervals) were used to quantify ANS function. Multivariate Cox proportional hazards models were fitted to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of VTAs or all-cause mortality in relation to ANS function at baseline and 6 months post-implantation. The cutoff value was determined using restrictive cubic splines. Multivariable logistic regression was further established to determine factors influencing postoperative HRV. Results:A total of 170 patients treated with CRT-D were eligible for analysis. During a median follow-up period of 50.8 months, 61 patients died and 69 patients experienced at least one spontaneous episode of VTAs. At 6 months after CRT implantation, 114 patients showed improvement in HRV, increasing from 66.4 +/- 19.4 ms to 76.7 +/- 21.2 ms. The postoperative HRV was associated with both all-cause mortality (HRs: 0.983; 95% CI: 0.968 to 0.998, p = 0.012) and VTAs (HRs: 0.973; 95% CI: 0.954 to 0.993, p = 0.008), and the relative risk would significantly increase when the postoperative HRV lower than 75 ms. After adjusting for basic ANS function and possible influencing factors, patients without diabetes (p = 0.018) and with higher daily physical activity (p = 0.041) could maintain higher postoperative HRV after CRT implantation. Conclusion:More than two-thirds of heart failure patients showed improvement in ANS function following CRT treatment. However, patients with diabetes and low daily physical activity levels have difficulty maintaining a higher postoperative HRV, which is associated with a worse clinical outcome.
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页数:9
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