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Addition of 24-Hour Heart Rate Variability Parameters to the Cardiovascular Health Study Stroke Risk Score and Prediction of Incident Stroke: The Cardiovascular Health Study.
Monday,2017-08-14 14:37 America/Los_Angeles — ecterry
| Title | Addition of 24-Hour Heart Rate Variability Parameters to the Cardiovascular Health Study Stroke Risk Score and Prediction of Incident Stroke: The Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2017 |
| Authors | Bodapati, RK, Kizer, JR, Kop, WJ, Kamel, H, Stein, PK |
| Journal | J Am Heart Assoc |
| Volume | 6 |
| Issue | 7 |
| Date Published | 2017 Jul 21 |
| ISSN | 2047-9980 |
| Abstract | <p><b>BACKGROUND: </b>Heart rate variability (HRV) characterizes cardiac autonomic functioning. The association of HRV with stroke is uncertain. We examined whether 24-hour HRV added predictive value to the Cardiovascular Health Study clinical stroke risk score (CHS-SCORE), previously developed at the baseline examination.</p><p><b>METHODS AND RESULTS: </b>N=884 stroke-free CHS participants (age 75.3±4.6), with 24-hour Holters adequate for HRV analysis at the 1994-1995 examination, had 68 strokes over ≤8 year follow-up (median 7.3 [interquartile range 7.1-7.6] years). The value of adding HRV to the CHS-SCORE was assessed with stepwise Cox regression analysis. The CHS-SCORE predicted incident stroke (HR=1.06 per unit increment, P=0.005). Two HRV parameters, decreased coefficient of variance of NN intervals (CV%, P=0.031) and decreased power law slope (SLOPE, P=0.033) also entered the model, but these did not significantly improve the c-statistic (P=0.47). In a secondary analysis, dichotomization of CV% (LOWCV% ≤12.8%) was found to maximally stratify higher-risk participants after adjustment for CHS-SCORE. Similarly, dichotomizing SLOPE (LOWSLOPE <-1.4) maximally stratified higher-risk participants. When these HRV categories were combined (eg, HIGHCV% with HIGHSLOPE), the c-statistic for the model with the CHS-SCORE and combined HRV categories was 0.68, significantly higher than 0.61 for the CHS-SCORE alone (P=0.02).</p><p><b>CONCLUSIONS: </b>In this sample of older adults, 2 HRV parameters, CV% and power law slope, emerged as significantly associated with incident stroke when added to a validated clinical risk score. After each parameter was dichotomized based on its optimal cut point in this sample, their composite significantly improved prediction of incident stroke during ≤8-year follow-up. These findings will require validation in separate, larger cohorts.</p> |
| DOI | 10.1161/JAHA.116.004305 |
| Alternate Journal | J Am Heart Assoc |
| PubMed ID | 28733431 |
ePub date:
17/07