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Entropy
Volume 23
Issue 6
10.3390/e23060753
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Article

The Value of Heart Rhythm Complexity in Identifying High-Risk Pulmonary Hypertension Patients

by
Shu-Yu Tang
1,2,
Hsi-Pin Ma
3,
Chi-Sheng Hung
1,
Ping-Hung Kuo
1,
Chen Lin
4,
Men-Tzung Lo
4,
Hsao-Hsun Hsu
5,
Yu-Wei Chiu
6,7,
Cho-Kai Wu
1,
Cheng-Hsuan Tsai
1,8,*,
Yen-Tin Lin
9,*,
Chung-Kang Peng
10 and
Yen-Hung Lin
1,*
1
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
2
Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan
3
Department of Electrical Engineering, National Tsing Hua University, Hsinchu 300044, Taiwan
4
Department of Biomedical Sciences and Engineering, National Central University, Taoyuan City 330, Taiwan
5
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
6
Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City 330, Taiwan
7
Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
8
Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City 220, Taiwan
9
Department of Internal Medicine, Taoyuan General Hospital, Taoyuan City 330, Taiwan
10
Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, USA
*
Authors to whom correspondence should be addressed.
Entropy 2021, 23(6), 753; https://doi.org/10.3390/e23060753
Submission received: 26 May 2021 / Revised: 9 June 2021 / Accepted: 12 June 2021 / Published: 15 June 2021
(This article belongs to the Special Issue The Role of Nonlinear Heart Rate Variability in Health and Disease)
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Abstract

Pulmonary hypertension (PH) is a fatal disease—even with state-of-the-art medical treatment. Non-invasive clinical tools for risk stratification are still lacking. The aim of this study was to investigate the clinical utility of heart rhythm complexity in risk stratification for PH patients. We prospectively enrolled 54 PH patients, including 20 high-risk patients (group A; defined as WHO functional class IV or class III with severely compromised hemodynamics), and 34 low-risk patients (group B). Both linear and non-linear heart rate variability (HRV) variables, including detrended fluctuation analysis (DFA) and multiscale entropy (MSE), were analyzed. In linear and non-linear HRV analysis, low frequency and high frequency ratio, DFAα1, MSE slope 5, scale 5, and area 6–20 were significantly lower in group A. Among all HRV variables, MSE scale 5 (AUC: 0.758) had the best predictive power to discriminate the two groups. In multivariable analysis, MSE scale 5 (p = 0.010) was the only significantly predictor of severe PH in all HRV variables. In conclusion, the patients with severe PH had worse heart rhythm complexity. MSE parameters, especially scale 5, can help to identify high-risk PH patients.
Keywords: pulmonary hypertension; heart rate variability; non-linear analysis; detrended fluctuation analysis; multiscale entropy pulmonary hypertension; heart rate variability; non-linear analysis; detrended fluctuation analysis; multiscale entropy

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MDPI and ACS Style

Tang, S.-Y.; Ma, H.-P.; Hung, C.-S.; Kuo, P.-H.; Lin, C.; Lo, M.-T.; Hsu, H.-H.; Chiu, Y.-W.; Wu, C.-K.; Tsai, C.-H.; et al. The Value of Heart Rhythm Complexity in Identifying High-Risk Pulmonary Hypertension Patients. Entropy 2021, 23, 753. https://doi.org/10.3390/e23060753

AMA Style

Tang S-Y, Ma H-P, Hung C-S, Kuo P-H, Lin C, Lo M-T, Hsu H-H, Chiu Y-W, Wu C-K, Tsai C-H, et al. The Value of Heart Rhythm Complexity in Identifying High-Risk Pulmonary Hypertension Patients. Entropy. 2021; 23(6):753. https://doi.org/10.3390/e23060753

Chicago/Turabian Style

Tang, Shu-Yu, Hsi-Pin Ma, Chi-Sheng Hung, Ping-Hung Kuo, Chen Lin, Men-Tzung Lo, Hsao-Hsun Hsu, Yu-Wei Chiu, Cho-Kai Wu, Cheng-Hsuan Tsai, and et al. 2021. "The Value of Heart Rhythm Complexity in Identifying High-Risk Pulmonary Hypertension Patients" Entropy 23, no. 6: 753. https://doi.org/10.3390/e23060753

APA Style

Tang, S.-Y., Ma, H.-P., Hung, C.-S., Kuo, P.-H., Lin, C., Lo, M.-T., Hsu, H.-H., Chiu, Y.-W., Wu, C.-K., Tsai, C.-H., Lin, Y.-T., Peng, C.-K., & Lin, Y.-H. (2021). The Value of Heart Rhythm Complexity in Identifying High-Risk Pulmonary Hypertension Patients. Entropy, 23(6), 753. https://doi.org/10.3390/e23060753

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