Heart rhythm complexity analysis in patients with inferior ST-elevation myocardial infarction
Shu-Yu Tang1, Hsi-Pin Ma2, Chen Lin3
1Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
Insights
Heart rhythm complexity (HRC) and left ventricular (LV) function decline after myocardial infarction. Multiscale entropy (MSE) slope predicts long-term LV systolic impairment, improving risk assessment for STEMI patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Physiology
Background:
- Heart rhythm complexity (HRC), a measure of heart rate variability (HRV), is crucial for assessing cardiovascular health.
- Investigating HRV and HRC changes post-myocardial infarction (MI) is vital for understanding disease progression and patient outcomes.
Purpose of the Study:
- To analyze serial changes in HRV and HRC metrics in inferior ST-elevation myocardial infarction (STEMI) patients up to one year post-infarction.
- To explore the association between HRC metrics and postinfarct left ventricular (LV) systolic impairment.
- To evaluate the predictive value of HRC for long-term LV systolic dysfunction.
Main Methods:
- Prospective enrollment of 33 inferior STEMI patients and 74 controls.
- Analysis of traditional linear HRV and HRC metrics, including detrended fluctuation analysis (DFA) and multiscale entropy (MSE).
- Serial echocardiography performed for one year to assess LV systolic function.
Main Results:
- STEMI patients showed lower standard deviation of RR interval (SDNN) and DFAα2 in the acute stage compared to controls.
- Low-frequency (LF) power remained elevated in STEMI patients throughout follow-up.
- Multiscale entropy (MSE) scale 5 was higher acutely but decreased over one year; MSE area under scale 1-5 was persistently lower and declined progressively in STEMI patients.
- MSE slope between scales 1-5 (MSE slope 1-5) demonstrated the best predictive value for long-term LV systolic impairment, enhancing existing risk models.
Conclusions:
- Inferior STEMI patients experience decreased HRC and LV contractility one year post-infarction.
- MSE slope 1-5 serves as a valuable predictor of postinfarct LV systolic impairment.
- HRC analysis, particularly MSE slope, offers significant potential for improving risk stratification in STEMI survivors.
Abstract:
Heart rhythm complexity (HRC), a subtype of heart rate variability (HRV), is an important tool to investigate cardiovascular disease. In this study, we aimed to analyze serial changes in HRV and HRC metrics in patients with inferior ST-elevation myocardial infarction (STEMI) within 1 year postinfarct and explore the association between HRC and postinfarct left ventricular (LV) systolic impairment. We prospectively enrolled 33 inferior STEMI patients and 74 control subjects and analyzed traditional linear HRV and HRC metrics in both groups, including detrended fluctuation analysis (DFA) and multiscale entropy (MSE). We also analyzed follow-up postinfarct echocardiography for 1 year. The STEMI group had significantly lower standard deviation of RR interval (SDNN), and DFAα2 within 7 days postinfarct (acute stage) comparing to control subjects. LF power was consistently higher in STEMI group during follow up. The MSE scale 5 was higher at acute stage comparing to control subjects and had a trend of decrease during 1-year postinfarct. The MSE area under scale 1-5 showed persistently lower than control subjects and progressively decreased during 1-year postinfarct. To predict long-term postinfarct LV systolic impairment, the slope between MSE scale 1 to 5 (slope 1-5) had the best predictive value. MSE slope 1-5 also increased the predictive ability of the linear HRV metrics in both the net reclassification index and integrated discrimination index models. In conclusion, HRC and LV contractility decreased 1 year postinfarct in inferior STEMI patients, and MSE slope 1-5 was a good predictor of postinfarct LV systolic impairment.
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