2015年9月
Multiscale Entropy of the Heart Rate Variability for the Prediction of an Ischemic Stroke in Patients with Permanent Atrial Fibrillation
PLOS ONE
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- 巻
- 10
- 号
- 9
- 開始ページ
- e0137144
- 終了ページ
- 記述言語
- 英語
- 掲載種別
- 研究論文(学術雑誌)
- DOI
- 10.1371/journal.pone.0137144
- 出版者・発行元
- PUBLIC LIBRARY SCIENCE
Background
Atrial fibrillation (AF) is a significant risk factor for ischemic strokes, and making a robust risk stratification scheme would be important. Few studies have examined whether nonlinear dynamics of the heart rate could predict ischemic strokes in AF. We examined whether a novel complexity measurement of the heart rate variability called multiscale entropy (MSE) was a useful risk stratification measure of ischemic strokes in patients with permanent AF.
Methods and Results
We examined 173 consecutive patients (age 69 +/- 11 years) with permanent AF who underwent 24-hour Holter electrocardiography from April 2005 to December 2006. We assessed several frequency ranges of the MSE and CHA(2)DS(2)-VASc score (1 point for congestive heart failure, hypertension, diabetes, vascular disease, an age 65 to 74 years, and a female sex and 2 points for an age >= 75 years and a stroke or transient ischemic attack). We found 22 (13%) incident ischemic strokes during a mean follow up of 3.8-years. The average value of the MSE in the very-low frequency subrange (90-300 s, MeanEn(VLF2)) was significantly higher in patients who developed ischemic strokes than in those who did not (0.68 +/- 0.15 vs. 0.60 +/- 0.14, P<0.01). There was no significant difference in the C-statistic between the CHA(2)DS(2)-VASc score and MeanEn(VLF2) (0.56; 95% confidence interval, 0.43-0.69 vs. 0.66; 95% confidence interval, 0.53-0.79). After an adjustment for the age, CHA(2)DS(2)-VASc score, and antithrombotic agent, a Cox hazard regression model revealed that the MeanEn(VLF2) was an independent predictor of an ischemic stroke (hazard ratio per 1-SD increment, 1.80; 95% confidence interval, 1.17-2.07, P<0.01).
Conclusion
The MeanEn(VLF2) in 24-hour Holter electrocardiography is a useful risk stratification measure of ischemic strokes during the long-term follow-up in patients with permanent AF.
Atrial fibrillation (AF) is a significant risk factor for ischemic strokes, and making a robust risk stratification scheme would be important. Few studies have examined whether nonlinear dynamics of the heart rate could predict ischemic strokes in AF. We examined whether a novel complexity measurement of the heart rate variability called multiscale entropy (MSE) was a useful risk stratification measure of ischemic strokes in patients with permanent AF.
Methods and Results
We examined 173 consecutive patients (age 69 +/- 11 years) with permanent AF who underwent 24-hour Holter electrocardiography from April 2005 to December 2006. We assessed several frequency ranges of the MSE and CHA(2)DS(2)-VASc score (1 point for congestive heart failure, hypertension, diabetes, vascular disease, an age 65 to 74 years, and a female sex and 2 points for an age >= 75 years and a stroke or transient ischemic attack). We found 22 (13%) incident ischemic strokes during a mean follow up of 3.8-years. The average value of the MSE in the very-low frequency subrange (90-300 s, MeanEn(VLF2)) was significantly higher in patients who developed ischemic strokes than in those who did not (0.68 +/- 0.15 vs. 0.60 +/- 0.14, P<0.01). There was no significant difference in the C-statistic between the CHA(2)DS(2)-VASc score and MeanEn(VLF2) (0.56; 95% confidence interval, 0.43-0.69 vs. 0.66; 95% confidence interval, 0.53-0.79). After an adjustment for the age, CHA(2)DS(2)-VASc score, and antithrombotic agent, a Cox hazard regression model revealed that the MeanEn(VLF2) was an independent predictor of an ischemic stroke (hazard ratio per 1-SD increment, 1.80; 95% confidence interval, 1.17-2.07, P<0.01).
Conclusion
The MeanEn(VLF2) in 24-hour Holter electrocardiography is a useful risk stratification measure of ischemic strokes during the long-term follow-up in patients with permanent AF.
- リンク情報
- ID情報
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- DOI : 10.1371/journal.pone.0137144
- ISSN : 1932-6203
- Web of Science ID : WOS:000360437700099