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Multiscale Entropy of the Heart Rate Variability for the Prediction of an Ischemic Stroke in Patients with Permanent Atrial Fibrillation.

Watanabe E, Kiyono K, Hayano J, Yamamoto Y, Inamasu J, Yamamoto M, Ichikawa T, Sobue Y, Harada M, Ozaki Y - PLoS ONE (2015)

Bottom Line: We assessed several frequency ranges of the MSE and CHA2DS2-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).There was no significant difference in the C-statistic between the CHA2DS2-VASc score and MeanEnVLF2 (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, CHA2DS2-VASc score, and antithrombotic agent, a Cox hazard regression model revealed that the MeanEnVLF2 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).

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.

ABSTRACT

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 CHA2DS2-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, MeanEnVLF2) 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 CHA2DS2-VASc score and MeanEnVLF2 (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, CHA2DS2-VASc score, and antithrombotic agent, a Cox hazard regression model revealed that the MeanEnVLF2 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 MeanEnVLF2 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.

No MeSH data available.


Related in: MedlinePlus

Ventricular response interval and its coarse-grained time series in patients with and without ischemic strokes.(A) A 75-year-old male had an ischemic stroke at 2 months after the recording. (B) A 45-year-old male who did not experience an ischemic stroke during 95 months after the recording. The VRI (upper panel) and its coarse-grained time series with a 240 sec (4 min) scale (lower panel) are shown. The coarse-grained time series is rescaled by subtracting its mean and dividing the differences by the SD (δ) of the VRI time series. VRI: ventricular response interval, MeanEnVLF2: mean value of sample entropy of the very-low frequency range 2 (90–300 s).
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pone.0137144.g002: Ventricular response interval and its coarse-grained time series in patients with and without ischemic strokes.(A) A 75-year-old male had an ischemic stroke at 2 months after the recording. (B) A 45-year-old male who did not experience an ischemic stroke during 95 months after the recording. The VRI (upper panel) and its coarse-grained time series with a 240 sec (4 min) scale (lower panel) are shown. The coarse-grained time series is rescaled by subtracting its mean and dividing the differences by the SD (δ) of the VRI time series. VRI: ventricular response interval, MeanEnVLF2: mean value of sample entropy of the very-low frequency range 2 (90–300 s).

Mentions: Fig 1 shows the SampEn of the VRI series of the patients who developed and did not develop ischemic strokes during the observation period. The MeanEnVLF2 was significantly greater in those who went on to experience a stroke. Fig 2 shows the representative VRIs and their coarse-grained time series from two patients. A patient who developed an ischemic stroke during the follow up had greater values of the mean value of sample entropy of the VLF2 range (MeanEnVLF2) and larger fluctuations (Fig 2A), while a patient that did not experience an ischemic stroke had a lower value of the MeanEnVLF2 and smaller fluctuations (Fig 2B).


Multiscale Entropy of the Heart Rate Variability for the Prediction of an Ischemic Stroke in Patients with Permanent Atrial Fibrillation.

Watanabe E, Kiyono K, Hayano J, Yamamoto Y, Inamasu J, Yamamoto M, Ichikawa T, Sobue Y, Harada M, Ozaki Y - PLoS ONE (2015)

Ventricular response interval and its coarse-grained time series in patients with and without ischemic strokes.(A) A 75-year-old male had an ischemic stroke at 2 months after the recording. (B) A 45-year-old male who did not experience an ischemic stroke during 95 months after the recording. The VRI (upper panel) and its coarse-grained time series with a 240 sec (4 min) scale (lower panel) are shown. The coarse-grained time series is rescaled by subtracting its mean and dividing the differences by the SD (δ) of the VRI time series. VRI: ventricular response interval, MeanEnVLF2: mean value of sample entropy of the very-low frequency range 2 (90–300 s).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556684&req=5

pone.0137144.g002: Ventricular response interval and its coarse-grained time series in patients with and without ischemic strokes.(A) A 75-year-old male had an ischemic stroke at 2 months after the recording. (B) A 45-year-old male who did not experience an ischemic stroke during 95 months after the recording. The VRI (upper panel) and its coarse-grained time series with a 240 sec (4 min) scale (lower panel) are shown. The coarse-grained time series is rescaled by subtracting its mean and dividing the differences by the SD (δ) of the VRI time series. VRI: ventricular response interval, MeanEnVLF2: mean value of sample entropy of the very-low frequency range 2 (90–300 s).
Mentions: Fig 1 shows the SampEn of the VRI series of the patients who developed and did not develop ischemic strokes during the observation period. The MeanEnVLF2 was significantly greater in those who went on to experience a stroke. Fig 2 shows the representative VRIs and their coarse-grained time series from two patients. A patient who developed an ischemic stroke during the follow up had greater values of the mean value of sample entropy of the VLF2 range (MeanEnVLF2) and larger fluctuations (Fig 2A), while a patient that did not experience an ischemic stroke had a lower value of the MeanEnVLF2 and smaller fluctuations (Fig 2B).

Bottom Line: We assessed several frequency ranges of the MSE and CHA2DS2-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).There was no significant difference in the C-statistic between the CHA2DS2-VASc score and MeanEnVLF2 (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, CHA2DS2-VASc score, and antithrombotic agent, a Cox hazard regression model revealed that the MeanEnVLF2 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).

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.

ABSTRACT

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 CHA2DS2-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, MeanEnVLF2) 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 CHA2DS2-VASc score and MeanEnVLF2 (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, CHA2DS2-VASc score, and antithrombotic agent, a Cox hazard regression model revealed that the MeanEnVLF2 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 MeanEnVLF2 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.

No MeSH data available.


Related in: MedlinePlus