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Heartbeat Chronicles: Decoding the Interplay of Echocardiography and Heart Rate Variability in Chronic Heart Failure Patients – Unraveling the Mysteries with Traditional and Advanced 24-Hour Holter ECG Parameters

Ştefania-Teodora Duca
Ştefania-Teodora Duca
, 
Ionuţ Tudorancea
Ionuţ Tudorancea
, 
Radu-Ştefan Miftode
Radu-Ştefan Miftode
, 
Adriana Chetran
Adriana Chetran
, 
Alexandru-Dan Costache
Alexandru-Dan Costache
, 
D. Robert Pavăl
D. Robert Pavăl
 and 
Irina-Iuliana Costache-Enache
Irina-Iuliana Costache-Enache
   | May 30, 2024
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Article Category: Original Article
Published Online: May 30, 2024
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DOI: https://doi.org/10.2478/rjc-2024-0009
Keywords
© 2024 Ștefania-Teodora Duca et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Correlation between left ventricular ejection fraction (%) and RMSSD (ms). RMSSD—square root of the mean of the squares of the successive differences between adjacent NN intervals.
Correlation between left ventricular ejection fraction (%) and RMSSD (ms). RMSSD—square root of the mean of the squares of the successive differences between adjacent NN intervals.

Figure 2

Association between the E/A ratio and both acceleration (ms) and deceleration capacity (ms).
Association between the E/A ratio and both acceleration (ms) and deceleration capacity (ms).

Figure 3

Correlation between the E/A ratio and the Triangular Index (ms).
Correlation between the E/A ratio and the Triangular Index (ms).

Figure 4

Correlation between the E/E’ ratio and both deceleration capacity (ms) and the Triangular Index (ms).
Correlation between the E/E’ ratio and both deceleration capacity (ms) and the Triangular Index (ms).

Figure 5

Association between mitral valve deceleration time (ms) and both acceleration (ms) and deceleration capacity (ms).
Association between mitral valve deceleration time (ms) and both acceleration (ms) and deceleration capacity (ms).

Figure 6

Association between the left atrial volume index (mL/m2) and RMSSD (ms) as well as PNN50 (%). RMSSD—square root of the mean of the squares of the successive differences between adjacent NN intervals, PNN50—ratio of NN50 to the total count of NN intervals.
Association between the left atrial volume index (mL/m2) and RMSSD (ms) as well as PNN50 (%). RMSSD—square root of the mean of the squares of the successive differences between adjacent NN intervals, PNN50—ratio of NN50 to the total count of NN intervals.

Summary of investigated parameter values

Minimum Maximum Mean Standard deviation
LVEDD (mm) 40 91 57.804 9.14
LVEF (%) 10 55 32 8.31
LVEDV (ml) 97 586 224.01 88.1
LVESV (ml) 55 513 157.1 76.8
E/A 0.15 3.27 1.32 0.75
E/E’ 3.5 28 12.87 5.83
E/E’ lateral 1.5 26 10.93 5.34
E/E’ septal 5.07 34.3 15.01 7.48
S’ lateral (cm/s) 0.03 0.13 0.06 0.02
S’ septal (cm/s) 0.03 0.11 0.06 0.02
MV Dec T (ms) 64 685 197.92 88.16
LAVI (mL/m2) 18.52 72.08 31.63 5.83
ePASP 9 93 32.91 16.69
Cardiac output (L) 1.72 7.77 4.76 1.44
Aortic Vmax (m/sec) 0.8 4.9 1.8 1
Mean AVG (mmHg) 2.58 95 17.71 1
SDNN (ms) 32 165 81.48 29.87
SDANN (ms) 24 140 68.87 27.15
SDNN Index (ms) 17 102 40.59 18.23
RMSSD (ms) 7 93 30.45 18.48
PNN50 (%) 0 43 7.58 10.17
Triangular Index (ms) 5.5 54.2 19.8 8.7
VLF (Hz) 126.8 10314.3 1665.67 1835.99
LF (Hz) 23.8 1775.9 338.88 380.22
HF (Hz) 4.5 2202.4 195 275.96
Deceleration capacity(ms) -4.96 9.05 3,92 2.33
Acceleration Capacity(ms) -10.72 -1.23 -4.9 2.20

The relationship between Echocardiographic Parameters and Holter ECG Parameters

SDNN SDANN SDNN Index RMSSD PNN50 Triangular Index VLF LF HF Deceleration capacity Acceleration Capacity
LVEDD (mm) Spearman’s rho 0.096 0.064 0.105 0.215 0.201 0.003 -0.01 -0.01 0.221 -0.087 -0.124
p-value 0.399 0.574 0.355 0.056 0.074 0.978 0.956 0.942 0.049 0.445 0.274
LVEF (%) Spearman’s rho 0.075 0.030 0.029 -0.294 -0.305 0.195 -0.01 0.039 -0.22 0.201 -0.142
p-value 0.507 0.793 0.802 0.008 0.006 0.083 0.967 0.731 0.054 0.075 0.210
LVEDV (ml) Spearman’s rho 0.080 0.053 0.115 0.153 0.169 0.003 0.134 0.009 0.083 -0.089 -0.016
p-value 0.479 0.638 0.311 0.175 0.134 0.977 0.237 0.935 0.467 0.433 0.886
LVESV (ml) Spearman’s rho 0.028 0.028 0.045 0.209 0.220 -0.097 0.070 -0.04 0.111 -0.191 0.074
p-value 0.807 0.805 0.691 0.063 0.050 0.390 0.539 0.750 0.325 0.090 0.513
E/A Spearman’s rho -0.19 -0.116 -0.218 0.127 0.139 -0.233 -0.21 -0.15 0.109 -0.381 0.226
p-value 0.098 0.303 0.052 0.261 0.220 0.037 0.061 0.173 0.337 < .001 0.044
E/E’ Spearman’s rho -0.11 -0.051 -0.145 0.177 0.225 -0.241 -0.13 -0.18 0.146 -0.239 0.208
p-value 0.319 0.653 0.199 0.116 0.045 0.031 0.239 0.121 0.196 0.033 0.064
E/E’ lateral Spearman’s rho -0.13 -0.065 -0.140 0.123 0.218 -0.250 -0.13 -0.16 0.129 -0.115 0.091
p-value 0.240 0.565 0.216 0.278 0.053 0.024 0.247 0.152 0.254 0.311 0.424
E/E’ septal Spearman’s rho -0.15 -0.099 -0.142 0.211 0.226 -0.243 -0.17 -0.18 0.142 -0.358 0.236
p-value 0.187 0.383 0.210 0.060 0.044 0.030 0.135 0.111 0.208 0.001 0.035
S’ lateral (cm/s) Spearman’s rho 0.122 0.074 0.092 -0.206 -0.224 0.282 -0.01 0.048 -0.20 0.163 -0.150
p-value 0.281 0.513 0.418 0.066 0.046 0.011 0.959 0.674 0.078 0.149 0.183
S’ septal (cm/s) Spearman’s rho 0.116 0.107 0.102 -0.263 -0.258 0.263 0.064 0.096 -0.22 0.311 -0.285
p-value 0.306 0.347 0.366 0.018 0.021 0.019 0.571 0.399 0.051 0.005 0.010
MV Dec T (ms) Spearman’s rho 0.221 0.125 0.222 -0.022 -0.010 0.251 0.290 0.221 0.027 0.309 -0.293
p-value 0.049 0.270 0.048 0.847 0.931 0.025 0.009 0.049 0.813 0.005 0.008
LAVI (mL/m2) Spearman’s rho 0.049 0.013 0.118 0.304 0.278 0.001 0.100 0.015 0.261 -0.208 -0.080
p-value 0.669 0.910 0.296 0.006 0.010 0.990 0.376 0.895 0.019 0.065 0.479
ePASP Spearman’s rho -0.01 -0.039 -0.045 0.292 0.278 -0.101 -0.17 -0.07 0.254 -0.316 0.064
p-value 0.975 0.732 0.694 0.009 0.013 0.373 0.138 0.512 0.023 0.004 0.570
Cardiac output (L) Spearman’s rho 0.030 0.107 -0.027 -0.237 -0.233 -0.032 0.084 0.053 -0.28 0.003 0.066
p-value 0.795 0.346 0.814 0.035 0.038 0.779 0.460 0.646 0.014 0.981 0.564
Aortic Vmax (m/sec) Spearman’s rho 0.004 -0.069 0.019 0.024 -0.011 0.009 0.072 0.103 0.008 0.151 -0.119
p-value 0.975 0.543 0.864 0.833 0.921 0.934 0.524 0.365 0.943 0.181 0.295
Mean AVG (mmHg) Spearman’s rho -0.05 -0.063 0.003 0.012 -0.005 -0.050 0.075 -0.12 -0.03 0.099 -0.073
p-value 0.638 0.577 0.976 0.918 0.963 0.658 0.506 0.273 0.823 0.384 0.520

Patient characteristics

Characteristics All sample (n=80)
Sex M – 59 (73.8 %)F – 21 (26.3 %)
Environment R – 44 (55.0 %)U – 36 (45.0 %)
Smoker YES – 39 (48.8 %)NO – 41 (51.2 %)
Alcohol consumption YES – 18 (22.5%)NO – 62 (77.5%)
Diabetes YES – 25 (31.3 %)NO – 55 (68.8 %)
CKD YES – 18 (22.5 %)NO – 62 (77.5 %)
Obesity YES – 22 (27.5 %)NO – 58 (72.5 %)
NYHA class I – 6 (7.5 %)II – 37 (46.3 %)III – 34 (42.5 %)IV – 3 (3.8 %)
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