Deceleration Capacity of Heart Rate Predicts Arrhythmic and Total Mortality in Heart Failure Patients

Background: Deceleration capacity (DC) of heart rate proved an independent mortality predictor in postmyocardial infarction patients. The original method (DCorig) may produce negative values (9% in our analyzed sample). We aimed to improve the method and to investigate if DC also predicts the arrhythmic mortality.

Methods: Time series from 221 heart failure patients was analyzed with DCorig and a new variant, the DCsgn, in which decelerations are characterized based on windows of four consecutive beats and not on anchors. After 41.2 months, 69 patients experienced sudden cardiac death (SCD) surrogate end points, while 61 died.

Results: (SCD+ vs SCD-group) DCorig: 3.7 ± 1.6 ms versus 4.6 ± 2.6 ms (P = 0.020) and DCsgn: 4.9 ± 1.7 ms versus 6.1 ± 2.2 ms (P < 0.001). After Cox regression (gender, age, left ventricular ejection fraction, filtered QRS, NSVT≥1/24h, VPBs≥240/24h, mean 24-h QTc, and each DC index added on the model separately), DCsgn (continuous) was an independent SCD predictor (hazard ratio [H.R.]: 0.742, 95% confidence intervals (C.I.): 0.631-0.871, P < 0.001). DCsgn ≤ 5.373 (dichotomous) presented 1.815 H.R. for SCD (95% C.I.: 1.080-3.049, P = 0.024), areas under curves (AUC)/receiver operator characteristic (ROC): 0.62 (DCorig) and 0.66 (DCsgn), P = 0.190 (chi-square). Results for deceased versus alive group: DCorig: 3.2 ± 2.0 ms versus 4.8 ± 2.4 ms (P < 0.001) and DCsgn: 4.6 ± 1.4 ms versus 6.2 ± 2.2 ms (P < 0.001). In Cox regression, DCsgn (continuous) presented H.R.: 0.686 (95% C.I. 0.546-0.862, P = 0.001) and DCsgn ≤ 5.373 (dichotomous) presented an H.R.: 2.443 for total mortality (TM) (95% C.I. 1.269-4.703, P = 0.008).

Auc/roc: 0.71 (DCorig) and 0.73 (DCsgn), P = 0.402.

Conclusions: DC predicts both SCD and TM. DCsgn avoids the negative values, improving the method in a nonstatistical important level.