Multiscale Entropy of the Heart Rate Variability for the Prediction of an Ischemic Stroke in Patients with Permanent Atrial Fibrillation

• Published in: PloS one 2015-09, Vol.10 (9), p.e0137144
• Main Authors: Watanabe, Eiichi, Kiyono, Ken, Hayano, Junichiro, Yamamoto, Yoshiharu, Inamasu, Joji, Yamamoto, Mayumi, Ichikawa, Tomohide, Sobue, Yoshihiro, Harada, Masehide, Ozaki, Yukio
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; Analysis; Atrial Fibrillation; Audio frequencies; Cardiac arrhythmia; Cardiology; Circadian rhythm; Clinical medicine; Complications and side effects; Confidence intervals; Congestive heart failure; Development and progression; Diabetes mellitus; Diabetes Mellitus - physiopathology; EKG; Electrocardiography; Electrocardiography, Ambulatory - methods; Entropy; Female; Fibrillation; Frequency ranges; Heart attacks; Heart failure; Heart Failure - complications; Heart Failure - physiopathology; Heart rate; Heart Rate - physiology; Humans; Hypertension; Hypertension - complications; Hypertension - physiopathology; Ischemia; Ischemic Attack, Transient - complications; Ischemic Attack, Transient - physiopathology; Male; Medicine; Middle Aged; Nonlinear dynamics; Nonlinear systems; Patient outcomes; Patients; Regression models; Risk Assessment; Risk Factors; Statistical analysis; Stroke; Stroke - etiology; Stroke - physiopathology; Time series; Transient ischemic attack; Variability; Vascular diseases; Watanabe, Ken
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0137144

Atrial fibrillation (AF) is a significant risk factor for ischemic strokes, and making a robust risk stratification scheme would be important. Few studies have examined whether nonlinear dynamics of the heart rate could predict ischemic strokes in AF. We examined whether a novel complexity measurement of the heart rate variability called multiscale entropy (MSE) was a useful risk stratification measure of ischemic strokes in patients with permanent AF. We examined 173 consecutive patients (age 69 ± 11 years) with permanent AF who underwent 24-hour Holter electrocardiography from April 2005 to December 2006. We assessed several frequency ranges of the MSE and CHA2DS2-VASc score (1 point for congestive heart failure, hypertension, diabetes, vascular disease, an age 65 to 74 years, and a female sex and 2 points for an age ≥ 75 years and a stroke or transient ischemic attack). We found 22 (13%) incident ischemic strokes during a mean follow up of 3.8-years. The average value of the MSE in the very-low frequency subrange (90-300 s, MeanEnVLF2) was significantly higher in patients who developed ischemic strokes than in those who did not (0.68 ± 0.15 vs. 0.60±0.14, P