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

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 %)

1 M – male; F – female; R – rural; U – urban; CKD – chronic kidney disease; NYHA- New York Heart Association

Table 2

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

1 LVEDD – left ventricular end-diastolic diameter, LVEF – left ventricular ejection fraction, LVEDV – left ventricular end-diastolic voume, LVESV – left ventricular end-systolic volume, E/A – peak velocity blood flow from left ventricular relaxation in early diastole/ peak velocity flow in late diastole caused by atrial contraction, E/e’ – left ventricular transmitral early diastolic filling velocity/left ventricular early diastolic myocardial velocity, E/E’ lateral – peak velocity blood flow from left ventricular relaxation in early diastole/ lateral left ventricular early diastolic myocardial velocity, E/E’ septal – left ventricular transmitral early diastolic filling velocity/septal wall of left ventricular early diastolic myocardial velocity, MV Dec T – mitral valve deceleration time, S’ lateral – systolic excursion velocity of lateral wall of the left ventricle, S’ septal – systolic excursion velocity of the septum of left ventricle, LAVI – left atrial volume index, MAPSE – mitral annular plane systolic excursion, SDNN – standard deviation of RR intervals for the entire duration, SDANN – standard deviation of the averages of NN intervals in each 5 min segment across the entire recording, SDNN index – mean of the 5 min normal-to-normal intervals throughout the complete recording, RMSSD – square root of the mean of the squares of the successive differences between adjacent NN intervals, PNN50 – the ratio of NN50 to the total count of NN intervals, hF – high frequency, lF – low frequency, vlF – very low frequency.

Table 3

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

1 LVEDD – left ventricular end-diastolic diameter, LVEF – left ventricular ejection fraction, LVEDV – left ventricular end-diastolic voume, LVESV – left ventricular end-systolic volume, E/A – peak velocity blood flow from left ventricular relaxation in early diastole/ peak velocity flow in late diastole caused by atrial contraction, E/e’ – left ventricular transmitral early diastolic filling velocity/left ventricular early diastolic myocardial velocity, E/E’ lateral – peak velocity blood flow from left ventricular relaxation in early diastole/ lateral left ventricular early diastolic myocardial velocity, E/E’ septal – left ventricular transmitral early diastolic filling velocity/septal wall of left ventricular early diastolic myocardial velocity, MV Dec T – mitral valve deceleration time, S’ lateral – systolic excursion velocity of lateral wall of the left ventricle, S’ septal – systolic excursion velocity of the septum of left ventricle, LAVI – left atrial volume index, MAPSE – mitral annular plane systolic excursion, SDNN – standard deviation of RR intervals for the entire duration, SDANN – standard deviation of the averages of NN intervals in each 5 min segment across the entire recording, SDNN index – mean of the 5 min normal-to-normal intervals throughout the complete recording, RMSSD – square root of the mean of the squares of the successive differences between adjacent NN intervals, PNN50 – the ratio of NN50 to the total count of NN intervals, hF – high frequency, lF – low frequency, vlF – very low frequency.

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.

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

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

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

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

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.

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DOI: https://doi.org/10.2478/rjc-2024-0009 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X

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Language: English, Romanian

Page range: 68 - 82

Published on: May 30, 2024

Published by: Romanian Society of Cardiology

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

Chronic Heart Failure,

Heart Rate Variability,

Related subjects:

Pediatrics and juvenile medicine,

Paediatric cardiology,

Surgery,

Cardiac surgery

© 2024 Ştefania-Teodora Duca, Ionuţ Tudorancea, Radu-Ştefan Miftode, Adriana Chetran, Alexandru-Dan Costache, D. Robert Pavăl, Irina-Iuliana Costache-Enache, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 34 (2024): Issue 2 (June 2024)

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

Figures & Tables

Table 1

Table 2

Table 3

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

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