Association between circadian Holter ECG changes and sudden cardiac death in patients with Chagas heart disease

Objective: Chagas disease (ChD) is a parasitic illness, largely spread over South America. ChD usually causes progressive myocardium damage, either by direct parasite action or through autoimmune response. Sudden cardiac death (SCD) is prevalent in the early disease stages, being associated with a h...

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Bibliographic Details
Published in:Physiological measurement 2020-03, Vol.41 (2), p.025006-025006
Main Authors: Alberto, Alex Chaves, Pedrosa, Roberto Coury, Zarzoso, Vicente, Nadal, Jurandir
Format: Article
Language:English
Subjects:
Bioengineering
Chagas Disease - complications
Chagas heart disease
Circadian Rhythm
Computer Science
Death, Sudden, Cardiac
Electrocardiography
Female
Heart Rate
heart rate turbulence
heart rate variability
Holter ECG
Humans
Life Sciences
Male
Middle Aged
Signal and Image Processing
Signal Processing, Computer-Assisted
sudden cardiac death
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Summary:Objective: Chagas disease (ChD) is a parasitic illness, largely spread over South America. ChD usually causes progressive myocardium damage, either by direct parasite action or through autoimmune response. Sudden cardiac death (SCD) is prevalent in the early disease stages, being associated with a high variety of ectopic cardiac beats. This study aims at applying heart rate variability (HRV) and heart rate turbulence (HRT) techniques over Holter electrocardiogram (ECG) records to investigate the association with SCD in Chagas heart disease (ChHD). Approach: From a retrospective evaluation of a local database, the Holter records from 78 outpatients (34 female) were divided into groups: SCD deaths (20) and alive patients (56). To consider circadian autonomic changes, the analysis was performed in three periods: (a) entire 24 h record, (b) 12 h daylight period, and (c) the remaining 12 h including night rest. Eight variables were extracted using HRV and HRT approaches from each record and analysed together with the left ventricular ejection fraction (LVEF) estimated by echocardiography. Main results: The set of parameters was reduced by both the forward- and backward-stepwise approach and classification was performed using the k-nearest neighbours method and a leave-one-out cross-validation in a set of ten bootstrap trials, where SCD data were randomly taken and repositioned to balance the groups. The best 24 h model predicted SCD with 89.9%  ±  0.9% accuracy using three HRV variables. The use of 12 h segments increased the accuracy up to 91.0%  ±  1.2% in a model with the standard deviation parameter measured during the day (SDNNday) and night (SDNNnight). Although considered as playing a major role in SCD, LVEF did not show an association with SCD in this sample. Significance: The degree of HRV and its circadian changes are associated with SCD in ChHD patients.
ISSN:0967-3334
1361-6579
1361-6579
DOI:10.1088/1361-6579/ab6ebc