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SCD-HeFT: Use of R-R interval statistics for long-term risk stratification for arrhythmic sudden cardiac death.

Publication ,  Journal Article
Au-Yeung, W-TM; Reinhall, PG; Poole, JE; Anderson, J; Johnson, G; Fletcher, RD; Moore, HJ; Mark, DB; Lee, KL; Bardy, GH
Published in: Heart Rhythm
October 2015

BACKGROUND: In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), a significant fraction of the patients with congestive heart failure ultimately did not die suddenly of arrhythmic causes. Patients with CHF will benefit from better tools to identify if implantable cardioverter-defibrillator (ICD) therapy is needed. OBJECTIVES: We aimed to identify predictor variables from baseline SCD-HeFT patients' R-R intervals that correlate to arrhythmic sudden cardiac death (SCD) and mortality and to design an ICD therapy screening test. METHODS: Ten predictor variables were extracted from prerandomization Holter data from 475 patients enrolled in the ICD arm of the SCD-HeFT by using novel and traditional heart rate variability methods. All variables were correlated to SCD using the Mann-Whitney-Wilcoxon test and receiver operating characteristic analysis. ICD therapy screening tests were designed by minimizing the cost of false classifications. Survival analysis, including log-rank test and Cox models, was also performed. RESULTS: A short-term fractal exponent, α1, and a long-term fractal exponent, α2, from detrended fluctuation analysis, the ratio of low- to high-frequency power, the number of premature ventricular contractions per hour, and the heart rate turbulence slope are all statistically significant for predicting the occurrences of SCD (P < .001) and survival (log-rank, P < .01). The most powerful multivariate predictor tool using the Cox proportional hazards regression model was α2 with a hazard ratio of 0.0465 (95% confidence interval 0.00528-0.409; P < .01). CONCLUSION: Predictor variables extracted from R-R intervals correlate to the occurrences of SCD and distinguish survival functions among patients with ICDs in SCD-HeFT. We believe that SCD prediction models should incorporate Holter-based R-R interval analysis to refine ICD patient selection, especially to exclude patients who are unlikely to benefit from ICD therapy.

Duke Scholars

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

October 2015

Volume

12

Issue

10

Start / End Page

2058 / 2066

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Au-Yeung, W.-T., Reinhall, P. G., Poole, J. E., Anderson, J., Johnson, G., Fletcher, R. D., … Bardy, G. H. (2015). SCD-HeFT: Use of R-R interval statistics for long-term risk stratification for arrhythmic sudden cardiac death. Heart Rhythm, 12(10), 2058–2066. https://doi.org/10.1016/j.hrthm.2015.06.030
Au-Yeung, Wan-Tai M., Per G. Reinhall, Jeanne E. Poole, Jill Anderson, George Johnson, Ross D. Fletcher, Hans J. Moore, Daniel B. Mark, Kerry L. Lee, and Gust H. Bardy. “SCD-HeFT: Use of R-R interval statistics for long-term risk stratification for arrhythmic sudden cardiac death.Heart Rhythm 12, no. 10 (October 2015): 2058–66. https://doi.org/10.1016/j.hrthm.2015.06.030.
Au-Yeung W-TM, Reinhall PG, Poole JE, Anderson J, Johnson G, Fletcher RD, et al. SCD-HeFT: Use of R-R interval statistics for long-term risk stratification for arrhythmic sudden cardiac death. Heart Rhythm. 2015 Oct;12(10):2058–66.
Au-Yeung, Wan-Tai M., et al. “SCD-HeFT: Use of R-R interval statistics for long-term risk stratification for arrhythmic sudden cardiac death.Heart Rhythm, vol. 12, no. 10, Oct. 2015, pp. 2058–66. Pubmed, doi:10.1016/j.hrthm.2015.06.030.
Au-Yeung W-TM, Reinhall PG, Poole JE, Anderson J, Johnson G, Fletcher RD, Moore HJ, Mark DB, Lee KL, Bardy GH. SCD-HeFT: Use of R-R interval statistics for long-term risk stratification for arrhythmic sudden cardiac death. Heart Rhythm. 2015 Oct;12(10):2058–2066.
Journal cover image

Published In

Heart Rhythm

DOI

EISSN

1556-3871

Publication Date

October 2015

Volume

12

Issue

10

Start / End Page

2058 / 2066

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Time Factors
  • Survival Rate
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans