Male Patients With Dilated Cardiomyopathy Exhibiting a Higher Heart Rate Acceleration Capacity or a Lower Deceleration Capacity Are at Higher Risk of Cardiac Death

Yichen Yang; Fengyan Wang; Cao Zou; Hongkai Dong; Xingmei Huang; Bingyuan Zhou; Xun Li; Xiangjun Yang

doi:10.3389/fphys.2018.01774

Male Patients With Dilated Cardiomyopathy Exhibiting a Higher Heart Rate Acceleration Capacity or a Lower Deceleration Capacity Are at Higher Risk of Cardiac Death

Front Physiol. 2018 Dec 7:9:1774. doi: 10.3389/fphys.2018.01774. eCollection 2018.

Authors

Yichen Yang¹, Fengyan Wang², Cao Zou¹, Hongkai Dong³, Xingmei Huang⁴, Bingyuan Zhou⁵, Xun Li¹, Xiangjun Yang¹

Affiliations

¹ Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
² Department of Cardiology, People's Hospital of Rizhao, Rizhao, China.
³ Department of Cardiology, Yuncheng Central Hospital, Yuncheng, China.
⁴ Department of Electrocardiography, The First Affiliated Hospital of Soochow University, Suzhou, China.
⁵ Department of Echocardiography, The First Affiliated Hospital of Soochow University, Suzhou, China.

Abstract

The effects of dilated cardiomyopathy (DCM) on cardiac autonomic regulation and electrophysiology, and the consequences of such changes, remain unclear. We evaluated the associations between heart rate acceleration capacity (AC) and deceleration capacity (DC), heart structural and functional changes, and cardiac death in 202 healthy controls and 100 DCM patients. The DC was lower and the AC was higher in DCM patients (both males and females). Multivariable, linear, logistic regression analyses revealed that in males, age was positively associated with AC in healthy controls (N = 85); the left atrial diameter (LAD) was positively and the left ventricular ejection fraction (LVEF) was negatively associated with AC in DCM patients (N = 65); age was negatively associated with DC in healthy controls (N = 85); and the LAD was negatively and the LVEF was positively associated with DC in DCM patients (N = 65). In females, only age was associated with either AC or DC in healthy controls (N = 117). Kaplan-Meier analysis revealed that male DCM patients with greater LADs (≥46.5 mm) (long-rank chi-squared value = 11.1, P = 0.001), an elevated AC (≥-4.75 ms) (log-rank chi-squared value = 6.8, P = 0.009), and a lower DC (≤4.72 ms) (log-rank chi-squared value = 9.1, P = 0.003) were at higher risk of cardiac death within 60 months of follow-up. In conclusion, in males, DCM significantly affected both the AC and DC; a higher AC or a lower DC increased the risk of cardiac death.

Keywords: cardiac autonomic regulation; dilated cardiomyopathy; electrophysiology; heart rate acceleration capacity; heart rate deceleration capacity.