The Prognostic Value of Non-Linear Analysis of Heart Rate Variability in Patients with Congestive Heart Failure-A Pilot Study of Multiscale Entropy

Aims: The influences of nonstationarity and nonlinearity on heart rate time series can be mathematically qualified or quantified by multiscale entropy (MSE). The aim of this study is to investigate the prognostic value of parameters derived from MSE in the patients with systolic heart failure. Methods and Results: Patients with systolic heart failure were enrolled in this study. One month after clinical condition being stable, 24-hour Holter electrocardiogram was recording. MSE as well as other standard parameters of heart rate variability (HRV) and detrended fluctuation analysis (DFA) were assessed. A total of 40 heart failure patients with a mea age of 56+/-16 years were enrolled and followed-up for 684+/-441 days. There were 25 patients receiving beta-blockers treatment. During follow-up period, 6 patients died or received urgent heart transplantation. The short-term exponent of DFA and the slope of MSE between scale 1 to 5 were significantly different between patients with or without b-blockers (p = 0.014 and p = 0.028). Only the area under the MSE curve for scale 6 to 20 (Area(6-20)) showed the strongest predictive power between survival (n = 34) and mortality (n = 6) groups among all the parameters. The value of Area(6-20) <= 21.2 served as a significant predictor of mortality or heart transplant (p = 0.0014). Conclusion: The area under the MSE curve for scale 6 to 20 is not relevant to beta-blockers and could further warrant independent risk stratification for the prognosis of CHF patients.