TY - JOUR
T1 - Revisiting Left Ventricular Ejection Fraction Levels
T2 - A Circadian Heart Rate Variability-Based Approach
AU - Jelinek, Herbert F.
AU - Saleem, Shiza
AU - Hadjileontiadis, Leontios J.
AU - Khandoker, Ahsan H.
N1 - Funding Information:
This work was supported in part by the Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates, under Award 8474000132, and in part by the Department of Education and Knowledge (ADEK), Abu Dhabi, under Award 29934.
Funding Information:
This work was supported in part by the Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates, under Award 8474000132, and in part by the Department of Education and Knowledge (ADEK), Abu Dhabi, under Award 29934. This work involved human subjects or animals in its research. Approval of all ethical and experimental procedures and protocols was granted by the Research Subject Review Board of the University of Rochester, and performed in line with the Declaration of Helsinki.
Publisher Copyright:
© 2013 IEEE.
PY - 2021
Y1 - 2021
N2 - Analysis of heart failure is important in clinical practice to ensure coronary artery disease (CAD) patients will be provided with appropriate timely treatment. The current gold-standard, echocardiography, although reliable, provides a once-off left ventricular ejection fraction (LVEF) measurement and does not provide information about heart function disturbances during day/night cardiac cycles. Additionally, the discrimination between heart failure with preserved and mid-range ejection fraction remains challenging in echocardiography tests. In this vein, this study was sought to investigate the ability of heart rate variability (HRV) in categorizing CAD patients into multiple LVEF groups throughout the 24-hour circadian cycle and checking its agreement with established gold-standard echocardiography-based guidelines. A total of 92 CAD patients who have suffered from heart failure were included in this study. The newly introduced index, HRV ejection fraction (HRVEF), was based on optimizing indices extracted from HRV data, which are correlated with the sympathetic and parasympathetic nervous systems, to form group membership of the preserved (HFpEF), mid-range (HFmEF), and reduced (HFrEF) LVEF categories. HRVEF groups optimized on hourly basis through Jenks natural breaks algorithm exhibited a consistent pattern with a goodness of variance fit (GVF) of more than 70% accuracy during the late-night to early-morning (01:00-08:00) and evening (17:00-23:00) time periods. At these hours, several HRV indices were found significant (p-value ≤0.05) in differentiating between HRVEF groups using statistical analysis of variance (ANOVA) test. These features include the successive differences between normal heartbeats (RMSSD), low and high frequency (LF, HF) power, standard deviation of normal heartbeats (SD2), short-term scaling exponent (alpha1), and percentage of normal heartbeats in alternation segments (PAS). The findings of this study suggest HRV as a promising supplementary tool to the once-off echocardiography for timely LVEF measurements and heart failure prognosis. It paves the way towards multi-time HRV-based estimations for LVEF according to the association between LVEF and HRV indices to better demonstrate the circadian cardiac function at different LVEF levels in CAD patients.
AB - Analysis of heart failure is important in clinical practice to ensure coronary artery disease (CAD) patients will be provided with appropriate timely treatment. The current gold-standard, echocardiography, although reliable, provides a once-off left ventricular ejection fraction (LVEF) measurement and does not provide information about heart function disturbances during day/night cardiac cycles. Additionally, the discrimination between heart failure with preserved and mid-range ejection fraction remains challenging in echocardiography tests. In this vein, this study was sought to investigate the ability of heart rate variability (HRV) in categorizing CAD patients into multiple LVEF groups throughout the 24-hour circadian cycle and checking its agreement with established gold-standard echocardiography-based guidelines. A total of 92 CAD patients who have suffered from heart failure were included in this study. The newly introduced index, HRV ejection fraction (HRVEF), was based on optimizing indices extracted from HRV data, which are correlated with the sympathetic and parasympathetic nervous systems, to form group membership of the preserved (HFpEF), mid-range (HFmEF), and reduced (HFrEF) LVEF categories. HRVEF groups optimized on hourly basis through Jenks natural breaks algorithm exhibited a consistent pattern with a goodness of variance fit (GVF) of more than 70% accuracy during the late-night to early-morning (01:00-08:00) and evening (17:00-23:00) time periods. At these hours, several HRV indices were found significant (p-value ≤0.05) in differentiating between HRVEF groups using statistical analysis of variance (ANOVA) test. These features include the successive differences between normal heartbeats (RMSSD), low and high frequency (LF, HF) power, standard deviation of normal heartbeats (SD2), short-term scaling exponent (alpha1), and percentage of normal heartbeats in alternation segments (PAS). The findings of this study suggest HRV as a promising supplementary tool to the once-off echocardiography for timely LVEF measurements and heart failure prognosis. It paves the way towards multi-time HRV-based estimations for LVEF according to the association between LVEF and HRV indices to better demonstrate the circadian cardiac function at different LVEF levels in CAD patients.
KW - cardiac circadian rhythm
KW - coronary artery disease
KW - Heart failure
KW - heart rate variability
KW - Jenks natural breaks
KW - left ventricular ejection fraction
UR - http://www.scopus.com/inward/record.url?scp=85115718150&partnerID=8YFLogxK
U2 - 10.1109/ACCESS.2021.3114029
DO - 10.1109/ACCESS.2021.3114029
M3 - Article
AN - SCOPUS:85115718150
SN - 2169-3536
VL - 9
SP - 130111
EP - 130126
JO - IEEE Access
JF - IEEE Access
ER -
