Ischemic risk stratification by means of multivariate analysis of the heart rate variability

José F. Valencia, Montserrat Vallverdú, Alberto Porta, Andreas Voss, Rico Schroeder, Rafael Vázquez, Antonio Bayés De Luna, Pere Caminal

Research output: Contribution to journalArticle

Abstract

In this work, a univariate and multivariate statistical analysis of indexes derived from heart rate variability (HRV) was conducted to stratify patients with ischemic dilated cardiomyopathy (IDC) in cardiac risk groups. Indexes conditional entropy, refined multiscale entropy (RMSE), detrended fluctuation analysis, time and frequency analysis, were applied to the RR interval series (beat-to-beat series), for single and multiscale complexity analysis of the HRV in IDC patients. Also, clinical parameters were considered. Two different end-points after a follow-up of three years were considered: (i) analysis A, with 151 survivor patients as a low risk group and 13 patients that suffered sudden cardiac death as a high risk group; (ii) analysis B, with 192 survivor patients as a low risk group and 30 patients that suffered cardiac mortality as a high risk group. A univariate and multivariate linear discriminant analysis was used as a statistical technique for classifying patients in risk groups. Sensitivity (Sen) and specificity (Spe) were calculated as diagnostic criteria in order to evaluate the performance of the indexes and their linear combinations. Sen and Spe values of 80.0% and 72.9%, respectively, were obtained during daytime by combining one clinical parameter and one index from RMSE, and during nighttime Sen = 80% and Spe = 73.4% were attained by combining one clinical factor and two indexes from RMSE. In particular, relatively long time scales were more relevant for classifying patients into risk groups during nighttime, while during daytime shorter scales performed better. The results suggest that the left atrial size, indexed to body surface and RMSE indexes are those that allow enhanced classification of ischemic patients in their respective risk groups, confirming that a single measurement is not enough to fully characterize ischemic risk patients and the clinical relevance of HRV complexity measures.

Original languageEnglish
Pages (from-to)325-338
Number of pages14
JournalPhysiological Measurement
Volume34
Issue number3
DOIs
Publication statusPublished - Mar 2013

Keywords

  • complexity analysis
  • heart rate variability
  • ischemic dilated cardiomyopathy
  • multivariate analysis
  • risk stratification

ASJC Scopus subject areas

  • Biophysics
  • Physiology
  • Physiology (medical)

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    Valencia, J. F., Vallverdú, M., Porta, A., Voss, A., Schroeder, R., Vázquez, R., Bayés De Luna, A., & Caminal, P. (2013). Ischemic risk stratification by means of multivariate analysis of the heart rate variability. Physiological Measurement, 34(3), 325-338. https://doi.org/10.1088/0967-3334/34/3/325