Back to Journals » Therapeutics and Clinical Risk Management » Volume 4 » Issue 4

Risk stratification for arrhythmic death in an emergency department cohort: a new method of nonlinear PD2i analysis of the ECG

Authors James E Skinner, Michael Meyer, William C Dalsey, Brian A Nester, George Ramalanjaona, et al

Published 8 August 2008 Volume 2008:4(4) Pages 689—697

DOI https://doi.org/10.2147/TCRM.S2741

James E Skinner1, Michael Meyer2, William C Dalsey3, Brian A Nester4, George Ramalanjaona5, Brian J O’Neil6, Antoinette Mangione7, Carol Terregino8, Abel Moreyra9, Daniel N Weiss10, Jerry M Anchin1, Una Geary11, Pamela Taggart12

1Vicor Technologies, Inc, Boca Raton, FL, USA; 2Max Planck Institute for Experimental Physiology, Goettingen, Germany; 3Kimbal Medical Center, Lakewood, NJ, USA; 4Lehigh Valley Hospital and Health Network, Allentown, PA, USA; 5St. Michaels Hospital, Newark, NJ, USA; 6William Beaumont Hospital, Royal Oak, MI, USA; 7Luitpolb Pharmaceuticals, Inc., Norristown, PA, USA; 8Cooper Medical Center, Camden, NJ, USA; 9Robert Wood Johnson Medical School, New Brunswick, NJ, USA; 10Florida Arrhythmia Consultants, Ft. Lauderdale, FL, USA; 11St. James Hospital, Dublin, Ireland; 12Albert Einstein Medical Center, Philadelphia, PA, USA

Abstract: Heart rate variability (HRV) reflects both cardiac autonomic function and risk of sudden arrhythmic death (AD). Indices of HRV based on linear stochastic models are independent risk factors for AD in postmyocardial infarction (MI) cohorts. Indices based on nonlinear deterministic models have a higher sensitivity and specificity for predicting AD in retrospective data. A new nonlinear deterministic model, the automated Point Correlation Dimension (PD2i), was prospectively evaluated for prediction of AD. Patients were enrolled (N = 918) in 6 emergency departments (EDs) upon presentation with chest pain and being determined to be at risk of acute MI (AMI) >7%. Brief digital ECGs (>1000 heartbeats, ∼15 min) were recorded and automated PD2i results obtained. Out-of-hospital AD was determined by modified Hinkle-Thaler criteria. All-cause mortality at 1 year was 6.2%, with 3.5% being ADs. Of the AD fatalities, 34% were without previous history of MI or diagnosis of AMI. The PD2i prediction of AD had sensitivity = 96%, specificity = 85%, negative predictive value = 99%, and relative risk >24.2 (p ≤ 0.001). HRV analysis by the time-dependent nonlinear PD2i algorithm can accurately predict risk of AD in an ED cohort and may have both life-saving and resource-saving implications for individual risk assessment.

Keywords: heart rate variability, sudden death, ventricular arrhythmias, chaos, non-linear

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 

 

Other articles by this author:

Readers of this article also read:

Process optimization and evaluation of novel baicalin solid nanocrystals

Yue PF, Li Y, Wan J, Wang Y, Yang M, Zhu WF, Wang CH, Yuan HL

International Journal of Nanomedicine 2013, 8:2961-2973

Published Date: 9 August 2013

One-step detection of circulating tumor cells in ovarian cancer using enhanced fluorescent silica nanoparticles

Kim JH, Chung HH, Jeong MS, Song MR, Kang KW, Kim JS

International Journal of Nanomedicine 2013, 8:2247-2257

Published Date: 21 June 2013

Isolated unilateral disk edema

Varner P

Clinical Optometry 2011, 3:13-55

Published Date: 27 July 2011

On the antiatherogenic effects of vitamin E: the search for the Holy Grail

Francesco Galli, Dimitrios Kirmizis, Dimitrios Chatzidimitriou

Vascular Health and Risk Management 2010, 6:69-71

Published Date: 16 February 2010

Interleukin-6 inhibitors in the treatment of rheumatoid arthritis

Stephanie Hennigan, Arthur Kavanaugh

Therapeutics and Clinical Risk Management 2008, 4:767-775

Published Date: 8 August 2008

Relative safety profiles of high dose statin regimens

Carlos Escobar, Rocio Echarri, Vivencio Barrios

Vascular Health and Risk Management 2008, 4:525-533

Published Date: 6 June 2008