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Published on: June 5, 2019
Heart rate variability predicts outcome in children with pulmonary arterial hypertension
Astrid E Lammers1, Elizabeth Munnery, Alison A Hislop
1Great Ormond Street Hospital for Children, UK. astridlammers@gmx.de
Insights
Heart rate variability (HRV) can predict outcomes in children with pulmonary arterial hypertension (PAH). Lower HRV values indicate a higher risk of death or need for lung transplantation in pediatric PAH patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Physiology
- Non-invasive Diagnostics
Background:
- Pulmonary arterial hypertension (PAH) in children requires objective risk stratification for treatment escalation and transplantation decisions.
- Current risk stratification methods need enhancement for accurate prognostication in pediatric PAH.
- Heart rate variability (HRV) is a potential non-invasive biomarker for assessing disease severity and prognosis.
Purpose of the Study:
- To evaluate the predictive value of heart rate variability (HRV) parameters for clinical outcomes in children diagnosed with severe pulmonary arterial hypertension (PAH).
- To determine if HRV can serve as an independent predictor of mortality or the need for lung transplantation in pediatric PAH.
- To correlate HRV measurements with established clinical, functional, and hemodynamic indicators of disease severity.
Main Methods:
- Collected Holter electrocardiogram data from 47 pediatric patients with PAH (idiopathic and associated forms).
- Analyzed key HRV parameters: SDNN, SDANN, and RMSSD.
- Assessed HRV in relation to WHO Functional Class, 6-minute-walk-test, echocardiographic, and hemodynamic data, and its predictive power for death or transplantation.
Main Results:
- Children who died or underwent transplantation exhibited significantly lower HRV values (SDANN, SDNN, RMSSD) compared to survivors (p<0.001).
- Univariate analysis revealed all HRV parameters predicted death or transplantation (p<0.05), with SDANN and SDNN also predicting mortality alone.
- Bivariate analysis confirmed SDANN and SDNN as independent predictors of outcome, irrespective of functional status, syncope, RV function, or hemodynamics.
Conclusions:
- Heart rate variability (HRV) is a valuable non-invasive tool for predicting poor outcomes in pediatric pulmonary arterial hypertension (PAH).
- HRV measurements can assist clinicians in identifying children with PAH who may require intensified medical therapy or consideration for lung transplantation.
- The findings support the integration of HRV assessment into routine clinical practice for risk stratification in pediatric PAH.
Introduction:
Objective risk stratifiers are required to assess need for escalation of medical therapy or listing for transplantation in children with pulmonary arterial hypertension (PAH). We aimed to assess whether heart rate variability (HRV) predicts outcome in children with severe PAH.
Patients And Methods:
Parameters of HRV [SDNN = standard deviation of normal-to-normal intervals, SDANN = standard deviation of mean values for normal-to-normal intervals over 5 min, and RMSSD = square root of the mean square differences of successive RR intervals] were determined from Holter electrocardiograms of 47 patients (27 male; mean age 11.4+/-5.5 years) with PAH (idiopathic PAH n=21; associated PAH n=26). HRV was assessed in relation to WHO Functional Class, six-minute-walk-test, echocardiographic and haemodynamic data, and as a predictor of death or lung transplantation.
Results:
The mean follow-up period was 19+/-11.5 months (1.8-49.1 months). Ten patients died and 7 underwent transplantation and these children had significantly lower values of HRV [SDANN (70.7+/-30.9 vs. 119.2+/-57.2), SDNN (79.5+/-30.5 vs. 129.9+/-63.6), and RMSSD (22.+/-11.7 vs. 47.7+/-34.5); p<0.001 for all]. On univariate Cox-proportional-hazards analysis all parameters of HRV predicted death or transplantation (p<0.05). SDANN and SDNN were also predictive of mortality alone (p<0.05). On bivariate analysis SDANN and SDNN predicted outcome independently of functional status, syncope, right ventricular function, and haemodynamic parameters.
Conclusions:
HRV is a useful, non-invasive means of predicting a poor outcome and hence need to escalate therapy in children with PAH.
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