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Association of preprocedural ultrashort-term heart rate variability with clinical outcomes after transcatheter aortic valve replacement: A nested, case-control, pilot study


1 Department on Anesthesiology and Perioperative Medicine, Tufts Medical Center; Department of Medicine, Tufts University School of Medicine, Boston, MA, United States, USA
2 Department on Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
3 Department of Medicine, Tufts University School of Medicine; Divison for Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA, United States, USA
4 Department on Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, United States

Correspondence Address:
Edward Hong
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington Street, Ziskind 6038, Boston, MA - 02118
United States
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_11_22

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Year : 2022  |  Volume : 25  |  Issue : 3  |  Page : 318-322

 

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Background: Because heart rate variability (HRV) has been linked to important clinical outcomes in various cardiovascular disease states, we investigated whether preprocedural ultrashort-term HRV (UST-HRV) differs between 1-year survivors and nonsurvivors after transcatheter aortic valve replacement (TAVR). Methods: In our single-center, retrospective, nested pilot study, we analyzed data from patients with severe aortic stenosis undergoing TAVR. All patients had preprocedural UST-HRV measured before the administration of any medications or any intervention. To investigate whether preprocedural HRV is associated with 1-year survival, we performed a logistic regression analysis controlling for Kansas City Cardiomyopathy Questionnaire 12 score. Results: In our parent cohort of 100 patients, 42 patients (28 survivors and 14 nonsurvivors) were included for analysis. Root mean square of successive differences (RMSSD) and standard deviation of NN intervals (SDNN) were lower in patients who survived to 1-year post TAVR compared to nonsurvivors [10 (IQR 8–23) vs 23 (IQR 17–33), P = 0.04 and 10 (IQR 7–16) vs 17 (IQR 11–40), P = 0.03, respectively]. Logistic regression demonstrated a trend in the association of preprocedure RMSSD with 1-year mortality and a 5% higher risk of 1-year mortality with each unit increment in UST-HRV using SDNN (OR 1.05; 95%CI 1.01–1.09, P = 0.02). Conclusion: Our data suggest an inverse relationship between preprocedural UST-HRV and 1-year survival post-TAVR. This finding highlights the potential complexity of HRV regulation in chronic vs acute illness. Prospective studies are needed to validate our findings and to determine whether UST-HRV can be used for risk stratification in patients with severe aortic stenosis.






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1 Department on Anesthesiology and Perioperative Medicine, Tufts Medical Center; Department of Medicine, Tufts University School of Medicine, Boston, MA, United States, USA
2 Department on Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
3 Department of Medicine, Tufts University School of Medicine; Divison for Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA, United States, USA
4 Department on Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, United States

Correspondence Address:
Edward Hong
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, 800 Washington Street, Ziskind 6038, Boston, MA - 02118
United States
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_11_22

Rights and Permissions

Background: Because heart rate variability (HRV) has been linked to important clinical outcomes in various cardiovascular disease states, we investigated whether preprocedural ultrashort-term HRV (UST-HRV) differs between 1-year survivors and nonsurvivors after transcatheter aortic valve replacement (TAVR). Methods: In our single-center, retrospective, nested pilot study, we analyzed data from patients with severe aortic stenosis undergoing TAVR. All patients had preprocedural UST-HRV measured before the administration of any medications or any intervention. To investigate whether preprocedural HRV is associated with 1-year survival, we performed a logistic regression analysis controlling for Kansas City Cardiomyopathy Questionnaire 12 score. Results: In our parent cohort of 100 patients, 42 patients (28 survivors and 14 nonsurvivors) were included for analysis. Root mean square of successive differences (RMSSD) and standard deviation of NN intervals (SDNN) were lower in patients who survived to 1-year post TAVR compared to nonsurvivors [10 (IQR 8–23) vs 23 (IQR 17–33), P = 0.04 and 10 (IQR 7–16) vs 17 (IQR 11–40), P = 0.03, respectively]. Logistic regression demonstrated a trend in the association of preprocedure RMSSD with 1-year mortality and a 5% higher risk of 1-year mortality with each unit increment in UST-HRV using SDNN (OR 1.05; 95%CI 1.01–1.09, P = 0.02). Conclusion: Our data suggest an inverse relationship between preprocedural UST-HRV and 1-year survival post-TAVR. This finding highlights the potential complexity of HRV regulation in chronic vs acute illness. Prospective studies are needed to validate our findings and to determine whether UST-HRV can be used for risk stratification in patients with severe aortic stenosis.






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