Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death

Deeptankar Demazumder, Worawan B. Limpitikul, Miguel Dorante, Swati Dey, Bhasha Mukhopadhyay, Yiyi Zhang, J. Randall Moorman, Alan Cheng, Ronald D. Berger, Eliseo Guallar, Steven R. Jones, Gordon F. Tomaselli

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Aims: The need for a readily available, inexpensive, non-invasive method for improved risk stratification of heart failure (HF) patients is paramount. Prior studies have proposed that distinct fluctuation patterns underlying the variability of physiological signals have unique prognostic value. We tested this hypothesis in an extensively phenotyped cohort of HF patients using EntropyXQT, a novel non-linear measure of cardiac repolarization dynamics. Methods and results: In a prospective, multicentre, observational study of 852 patients in sinus rhythm undergoing clinically indicated primary prevention implantable cardioverter-defibrillator (ICD) implantation (2003-10), exposures included demographics, history, physical examination, medications, laboratory results, serum biomarkers, ejection fraction, conventional electrocardiographic (ECG) analyses of heart rate and QT variability, and EntropyXQT. The primary outcome was first 'appropriate' ICD shock for ventricular arrhythmias. The secondary outcome was composite events (appropriate ICD shock and all-cause mortality). After exclusions, the cohort (n = 816) had a mean age of 60±13 years, 28% women, 36% African Americans, 56% ischaemic cardiomyopathy, and 29±16% Seattle HF risk score (SHFS) 5-year predicted mortality. Over 45±24 months, there were 134 appropriate shocks and 166 deaths. After adjusting for 30 exposures, the hazard ratios (comparing the 5th to 1st quintile of EntropyXQT) for primary and secondary outcomes were 3.29 (95% CI 1.74-6.21) and 2.28 (1.53-3.41), respectively. Addition of EntropyXQT to a model comprised of the exposures or SHFS significantly increased net reclassification and the ROC curve area. Conclusions: EntropyXQT measured during ICD implantation strongly and independently predicts appropriate shock and all-cause mortality over follow-up. EntropyXQT complements conventional risk predictors and has the potential for broad clinical application.

Original languageEnglish (US)
Pages (from-to)1818-1828
Number of pages11
JournalEuropace
Volume18
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Fingerprint

Implantable Defibrillators
Entropy
Primary Prevention
Sudden Death
Cardiac Arrhythmias
Shock
Heart Failure
Mortality
Cardiomyopathies
ROC Curve
African Americans
Multicenter Studies
Physical Examination
Observational Studies
Biomarkers
Heart Rate
History
Demography
Serum

Keywords

  • Chaos theory
  • Heart failure
  • Heart rate variability
  • Non-linear dynamics
  • QT variability
  • Risk prediction
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death. / Demazumder, Deeptankar; Limpitikul, Worawan B.; Dorante, Miguel; Dey, Swati; Mukhopadhyay, Bhasha; Zhang, Yiyi; Randall Moorman, J.; Cheng, Alan; Berger, Ronald D.; Guallar, Eliseo; Jones, Steven R.; Tomaselli, Gordon F.

In: Europace, Vol. 18, No. 12, 01.12.2016, p. 1818-1828.

Research output: Contribution to journalReview article

Demazumder, D, Limpitikul, WB, Dorante, M, Dey, S, Mukhopadhyay, B, Zhang, Y, Randall Moorman, J, Cheng, A, Berger, RD, Guallar, E, Jones, SR & Tomaselli, GF 2016, 'Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death', Europace, vol. 18, no. 12, pp. 1818-1828. https://doi.org/10.1093/europace/euv399
Demazumder, Deeptankar ; Limpitikul, Worawan B. ; Dorante, Miguel ; Dey, Swati ; Mukhopadhyay, Bhasha ; Zhang, Yiyi ; Randall Moorman, J. ; Cheng, Alan ; Berger, Ronald D. ; Guallar, Eliseo ; Jones, Steven R. ; Tomaselli, Gordon F. / Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death. In: Europace. 2016 ; Vol. 18, No. 12. pp. 1818-1828.
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abstract = "Aims: The need for a readily available, inexpensive, non-invasive method for improved risk stratification of heart failure (HF) patients is paramount. Prior studies have proposed that distinct fluctuation patterns underlying the variability of physiological signals have unique prognostic value. We tested this hypothesis in an extensively phenotyped cohort of HF patients using EntropyXQT, a novel non-linear measure of cardiac repolarization dynamics. Methods and results: In a prospective, multicentre, observational study of 852 patients in sinus rhythm undergoing clinically indicated primary prevention implantable cardioverter-defibrillator (ICD) implantation (2003-10), exposures included demographics, history, physical examination, medications, laboratory results, serum biomarkers, ejection fraction, conventional electrocardiographic (ECG) analyses of heart rate and QT variability, and EntropyXQT. The primary outcome was first 'appropriate' ICD shock for ventricular arrhythmias. The secondary outcome was composite events (appropriate ICD shock and all-cause mortality). After exclusions, the cohort (n = 816) had a mean age of 60±13 years, 28{\%} women, 36{\%} African Americans, 56{\%} ischaemic cardiomyopathy, and 29±16{\%} Seattle HF risk score (SHFS) 5-year predicted mortality. Over 45±24 months, there were 134 appropriate shocks and 166 deaths. After adjusting for 30 exposures, the hazard ratios (comparing the 5th to 1st quintile of EntropyXQT) for primary and secondary outcomes were 3.29 (95{\%} CI 1.74-6.21) and 2.28 (1.53-3.41), respectively. Addition of EntropyXQT to a model comprised of the exposures or SHFS significantly increased net reclassification and the ROC curve area. Conclusions: EntropyXQT measured during ICD implantation strongly and independently predicts appropriate shock and all-cause mortality over follow-up. EntropyXQT complements conventional risk predictors and has the potential for broad clinical application.",
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T1 - Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death

AU - Demazumder, Deeptankar

AU - Limpitikul, Worawan B.

AU - Dorante, Miguel

AU - Dey, Swati

AU - Mukhopadhyay, Bhasha

AU - Zhang, Yiyi

AU - Randall Moorman, J.

AU - Cheng, Alan

AU - Berger, Ronald D.

AU - Guallar, Eliseo

AU - Jones, Steven R.

AU - Tomaselli, Gordon F.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Aims: The need for a readily available, inexpensive, non-invasive method for improved risk stratification of heart failure (HF) patients is paramount. Prior studies have proposed that distinct fluctuation patterns underlying the variability of physiological signals have unique prognostic value. We tested this hypothesis in an extensively phenotyped cohort of HF patients using EntropyXQT, a novel non-linear measure of cardiac repolarization dynamics. Methods and results: In a prospective, multicentre, observational study of 852 patients in sinus rhythm undergoing clinically indicated primary prevention implantable cardioverter-defibrillator (ICD) implantation (2003-10), exposures included demographics, history, physical examination, medications, laboratory results, serum biomarkers, ejection fraction, conventional electrocardiographic (ECG) analyses of heart rate and QT variability, and EntropyXQT. The primary outcome was first 'appropriate' ICD shock for ventricular arrhythmias. The secondary outcome was composite events (appropriate ICD shock and all-cause mortality). After exclusions, the cohort (n = 816) had a mean age of 60±13 years, 28% women, 36% African Americans, 56% ischaemic cardiomyopathy, and 29±16% Seattle HF risk score (SHFS) 5-year predicted mortality. Over 45±24 months, there were 134 appropriate shocks and 166 deaths. After adjusting for 30 exposures, the hazard ratios (comparing the 5th to 1st quintile of EntropyXQT) for primary and secondary outcomes were 3.29 (95% CI 1.74-6.21) and 2.28 (1.53-3.41), respectively. Addition of EntropyXQT to a model comprised of the exposures or SHFS significantly increased net reclassification and the ROC curve area. Conclusions: EntropyXQT measured during ICD implantation strongly and independently predicts appropriate shock and all-cause mortality over follow-up. EntropyXQT complements conventional risk predictors and has the potential for broad clinical application.

AB - Aims: The need for a readily available, inexpensive, non-invasive method for improved risk stratification of heart failure (HF) patients is paramount. Prior studies have proposed that distinct fluctuation patterns underlying the variability of physiological signals have unique prognostic value. We tested this hypothesis in an extensively phenotyped cohort of HF patients using EntropyXQT, a novel non-linear measure of cardiac repolarization dynamics. Methods and results: In a prospective, multicentre, observational study of 852 patients in sinus rhythm undergoing clinically indicated primary prevention implantable cardioverter-defibrillator (ICD) implantation (2003-10), exposures included demographics, history, physical examination, medications, laboratory results, serum biomarkers, ejection fraction, conventional electrocardiographic (ECG) analyses of heart rate and QT variability, and EntropyXQT. The primary outcome was first 'appropriate' ICD shock for ventricular arrhythmias. The secondary outcome was composite events (appropriate ICD shock and all-cause mortality). After exclusions, the cohort (n = 816) had a mean age of 60±13 years, 28% women, 36% African Americans, 56% ischaemic cardiomyopathy, and 29±16% Seattle HF risk score (SHFS) 5-year predicted mortality. Over 45±24 months, there were 134 appropriate shocks and 166 deaths. After adjusting for 30 exposures, the hazard ratios (comparing the 5th to 1st quintile of EntropyXQT) for primary and secondary outcomes were 3.29 (95% CI 1.74-6.21) and 2.28 (1.53-3.41), respectively. Addition of EntropyXQT to a model comprised of the exposures or SHFS significantly increased net reclassification and the ROC curve area. Conclusions: EntropyXQT measured during ICD implantation strongly and independently predicts appropriate shock and all-cause mortality over follow-up. EntropyXQT complements conventional risk predictors and has the potential for broad clinical application.

KW - Chaos theory

KW - Heart failure

KW - Heart rate variability

KW - Non-linear dynamics

KW - QT variability

KW - Risk prediction

KW - Sudden cardiac death

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