Analysis of heart rate variability as a predictor of mortality in cardiovascular patients of intensive care unit

Abstract Objective Dynamic changes of heart rate variability (HRV) reflect autonomic dysfunction in cardiac disease. Some studies suggest the role of HRV in predicting intensive care unit (ICU) mortality. The main object of this study was analyzing the HRV to design an algorithm to predict mortality risk. Methods We evaluated 80 cardiovascular ICU patients (45 males and 45 females), ranging from 45 to 70 years. Common time and frequency domain analysis, non-linear Poincare plot and recurrence quantification analysis (RQA) were used to study the HRV in two episodes. The episodes include 8–4 h before death, and 4 h before death to death. Independent sample t -test was used as statistical analysis. Results Statistical analysis indicates that frequency domain and Poincare parameters such as LF/HF and SD2/SD1 show changes in transition to death episode ( p L mean , v max and RT measures showed meaningful changes ( p Conclusions Analysis of physiological variables shows that there are significant differences in RQA measures in episodes close to death. These changes can be interpreted as more stability and determinism behavior of HRV in episodes close to death. RQA parameters can be used together with HRV parameters for description and prediction of mortality risk in ICU patients.

[1]  Qin Wu,et al.  Non-sinus rhythm after heart surgery: permanent or not? A simple method can tell , 2012, Asian cardiovascular & thoracic annals.

[2]  R. Cohen,et al.  Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. , 1981, Science.

[3]  D. Ruelle,et al.  Recurrence Plots of Dynamical Systems , 1987 .

[4]  A. Folsom,et al.  Low Heart Rate Variability in a 2-Minute Rhythm Strip Predicts Risk of Coronary Heart Disease and Mortality From Several Causes: The ARIC Study , 2000, Circulation.

[5]  Mark S Roberts,et al.  Simulation and critical care modeling , 2004, Current opinion in critical care.

[6]  H. Wunsch,et al.  End-of-life decisions: a cohort study of the withdrawal of all active treatment in intensive care units in the United Kingdom , 2005, Intensive Care Medicine.

[7]  Fraser,et al.  Independent coordinates for strange attractors from mutual information. , 1986, Physical review. A, General physics.

[8]  G. Joynt,et al.  Limitation of life support: Frequency and practice in a Hong Kong intensive care unit* , 2004, Critical care medicine.

[9]  Kristian Kersting,et al.  Analysis of respiratory pressure-volume curves in intensive care medicine using inductive machine learning , 2002, Artif. Intell. Medicine.

[10]  J. L. Gall,et al.  A simplified acute physiology score for ICU patients , 1984, Critical care medicine.

[11]  W. T. Jones,et al.  Application of data mining to intensive care unit microbiologic data. , 1999, Emerging infectious diseases.

[12]  Lisa A Weissfeld,et al.  Advances in statistical methodology and their application in critical care , 2004, Current opinion in critical care.

[13]  A. Rosenberg Recent innovations in intensive care unit risk-prediction models , 2002, Current opinion in critical care.

[14]  F. Lemaire,et al.  Withholding and withdrawal of life support in intensive-care units in France: a prospective survey , 2001, The Lancet.

[15]  W. Knaus,et al.  The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. , 1991, Chest.

[16]  C. Sprung,et al.  The importance of religious affiliation and culture on end-of-life decisions in European intensive care units , 2007, Intensive Care Medicine.

[17]  D. Cook,et al.  Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study , 2001, Intensive Care Medicine.

[18]  A. Yazigi,et al.  Withholding and withdrawal of life-sustaining treatment in a Lebanese intensive care unit: a prospective observational study , 2005, Intensive Care Medicine.

[19]  Ferdinand J. Venditti,et al.  Reduced Heart Rate Variability and Mortalit Risk in an Elderly Cohort: The Framingham Heart Study , 1994, Circulation.

[20]  L. Peyrodie,et al.  Interpretation of RQA variables: Application to the prediction of epileptic seizures , 2006, 2006 8th international Conference on Signal Processing.

[21]  H. Kim,et al.  Application of Support Vector Machine for Prediction of Medication Adherence in Heart Failure Patients , 2010, Healthcare informatics research.

[22]  S. Lemeshow,et al.  A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. , 1993, JAMA.

[23]  J. Szalai,et al.  Death in two Canadian intensive care units: Institutional difference and changes over time , 2000, Critical care medicine.

[24]  A. Seely,et al.  Multiple organ dysfunction syndrome: Exploring the paradigm of complex nonlinear systems , 2000, Critical care medicine.

[25]  J. Marshall,et al.  From Celsus to Galen to Bone: The Illnesses, Syndromes, and Diseases of Acute Inflammation , 2001 .

[26]  Katharina Morik,et al.  Knowledge discovery and knowledge validation in intensive care , 2000, Artif. Intell. Medicine.

[27]  N. Marwan Encounters with neighbours : current developments of concepts based on recurrence plots and their applications , 2003 .

[28]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[29]  Feng Wen,et al.  An efficient method of addressing ectopic beats: new insight into data preprocessing of heart rate variability analysis , 2011, Journal of Zhejiang University SCIENCE B.

[30]  Manuel Filipe Santos,et al.  Mortality assessment in intensive care units via adverse events using artificial neural networks , 2006, Artif. Intell. Medicine.

[31]  H. Abarbanel,et al.  Determining embedding dimension for phase-space reconstruction using a geometrical construction. , 1992, Physical review. A, Atomic, molecular, and optical physics.

[32]  M. Piepoli,et al.  Spectral analysis of heart rate variability in the sepsis syndrome , 1993, Clinical Autonomic Research.

[33]  F. Piovano,et al.  Forgoing life sustaining treatments: differences and similarities between North America and Europe , 2006, Acta anaesthesiologica Scandinavica.

[34]  J. Zbilut,et al.  Embeddings and delays as derived from quantification of recurrence plots , 1992 .

[35]  H. Kantz,et al.  Optimizing of recurrence plots for noise reduction. , 2002, Physical review. E, Statistical, nonlinear, and soft matter physics.

[36]  Jürgen Kurths,et al.  Recurrence plots for the analysis of complex systems , 2009 .

[37]  Maurice Bruynooghe,et al.  Mining data from intensive care patients , 2007, Adv. Eng. Informatics.

[38]  Marimuthu Palaniswami,et al.  Do existing measures of Poincare plot geometry reflect nonlinear features of heart rate variability? , 2001, IEEE Transactions on Biomedical Engineering.

[39]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[40]  A. Mazzeo,et al.  Heart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care , 2011, Acta anaesthesiologica Scandinavica.

[41]  G. Clermont,et al.  Towards Understanding Pathophysiology in Critical Care: The Human Body as a Complex System , 2001 .

[42]  Jürgen Kurths,et al.  Influence of observational noise on the recurrence quantification analysis , 2002 .

[43]  Charles L Sprung,et al.  End-of-life practices in European intensive care units: the Ethicus Study. , 2003, JAMA.

[44]  Peter J.F. Lucas Bayesian analysis, pattern analysis, and data mining in health care , 2004, Current opinion in critical care.

[45]  William A Knaus,et al.  APACHE 1978-2001: the development of a quality assurance system based on prognosis: milestones and personal reflections. , 2002, Archives of surgery.

[46]  C. Sprung,et al.  End-of-life practices in 282 intensive care units: data from the SAPS 3 database , 2009, Intensive Care Medicine.

[47]  V. Rajput,et al.  End-of-life practices in 282 intensive care units: data from the SAPS 3 database , 2010 .

[48]  Pedro Larrañaga,et al.  Using Bayesian networks in the construction of a bi-level multi-classifier. A case study using intensive care unit patients data , 2001, Artif. Intell. Medicine.

[49]  W. Knaus The APACHE III Prognostic System , 1992 .

[50]  H L Kennedy Heart rate variability--a potential, noninvasive prognostic index in the critically ill patient. , 1998, Critical care medicine.