Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients
Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients
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DOI：
10.2215/cjn.09430911
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发表时间：
2012-09-01
影响因子：
9.8
通讯作者：
Hayano, Junichiro
中科院分区：
文献类型：
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作者：
Suzuki, Mari;Hiroshi, Takahashi;Hayano, Junichiro
背景与目的心率变异性(HRV)的非线性测量近年来在各种临床环境中作为强有力的风险预测指标而受到关注。这项研究考察了它们是否改善了血液透析患者的风险分层。设计、设置、参与者和测量以评估心率震荡、减速能力、分形尺度指数(α(1))和其他传统的HRV测量，281名血液透析患者在2002年1月至2004年5月期间接受了24小时心电图检查，并进行了随访。结果在中位数87个月的随访期内，77名患者(27%)死亡。年龄、左心室射血分数、血清白蛋白、C反应蛋白和磷酸X钙独立预测死亡率。虽然所有的非线性HRV指标都可以预测死亡率，但在调整了临床危险因素后，只有降低的标度指数α(1)仍然显著(每0.25次减少的危险比为1.46；95%可信区间[95%CI]，1.16-1.85)。将α(1)纳入由临床危险因素组成的预测模型后，C统计量从0.84增加到0.87(P=0.03)，50.8%(95%可信区间，20.2~83.7)的5年死亡率持续净改善。A1的预测力与年龄呈交互作用(P=0.02)，在老年患者中尤为明显
Background and objectives Nonlinear measures of heart rate variability (HRV) have gained recent interest as powerful risk predictors in various clinical settings. This study examined whether they improve risk stratification in hemodialysis patients.Design, setting, participants, & measurements To assess heart rate turbulence, deceleration capacity, fractal scaling exponent (alpha(1)), and other conventional HRV measures, 281 hemodialysis patients underwent 24-hour electrocardiography between January 2002 and May 2004 and were subsequently followed up.Results During a median 87-month follow-up, 77 patients (27%) died. Age, left ventricular ejection fraction, serum albumin, C-reactive protein, and calcium X phosphate independently predicted mortality. Whereas all nonlinear HRV measures predicted mortality, only decreased scaling exponent alpha(1) remained significant after adjusting for clinical risk factors (hazard ratio per a 0.25 decrement, 1.46; 95% confidence interval [95% CI], 1.16-1.85). The inclusion of alpha(1) into a prediction model composed of clinical risk factors increased the C statistic from 0.84 to 0.87 (P=0.03), with 50.8% (95% CI, 20.2-83.7) continuous net reclassification improvement for 5-year mortality. The predictive power of a1 showed an interaction with age (P=0.02) and was particularly strong in patients aged