Is the Median Hourly Ambulatory Heart Rate Range Helpful in Stratifying Mortality Risk among Newly Diagnosed Atrial Fibrillation Patients?
<b>Background:</b> The application of heart rate variability is problematic in patients with atrial fibrillation (AF). This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range (<inline-formula><math xmlns="htt...
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| Autores principales: | , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
MDPI AG
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/e156f099e7934e1399c547e0f79a76d4 |
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| Sumario: | <b>Background:</b> The application of heart rate variability is problematic in patients with atrial fibrillation (AF). This study aims to explore the associations between all-cause mortality and the median hourly ambulatory heart rate range (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula>) compared with other parameters obtained from the Holter monitor in patients with newly diagnosed AF. <b>Material and Methods:</b> A total of 30 parameters obtained from 521 persistent AF patients’ Holter monitor were analyzed retrospectively from 1 January 2010 to 31 July 2014. Every patient was followed up to the occurrence of death or the end of 30 June 2017. <b>Results:</b><inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> was the most feasible Holter parameter. Lower <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> was associated with increased risk of all-cause mortality (adjusted hazard ratio [aHR] for every 10-bpm reduction: 2.70, 95% confidence interval [CI]: 1.75–4.17, <i>p</i> < 0.001). The C-statistic of <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> alone was 0.707 (95% CI: 0.658–0.756), and 0.697 (95% CI: 0.650–0.744) for the CHA2DS2-VASc score alone. By combining <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> with the CHA2DS2-VASc score, the C-statistic could improve to 0.764 (95% CI: 0.722–0.806). While using 20 bpm as the cut-off value, the aHR was 3.66 (95% CI: 2.05–6.52) for patients with <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> < 20 bpm in contrast to patients with <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> ≥ 20 bpm. <b>Conclusions:</b><inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msub><mrow><mover accent="true"><mrow><mi>A</mi><mi>H</mi><mi>R</mi><mi>R</mi></mrow><mo stretchy="true">˜</mo></mover></mrow><mrow><mn>24</mn><mi>h</mi><mi>r</mi></mrow></msub></mrow></semantics></math></inline-formula> could be helpful for risk stratification for AF in addition to the CHA2DS2-VASc score. |
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