Association between cardiac autonomic function and physical activity in patients at high risk of sudden cardiac death: a cohort study View Full Text


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Article Info

DATE

2021-09-20

AUTHORS

Xuerong Sun, Shuang Zhao, Keping Chen, Wei Hua, Yangang Su, Xin Liu, Wei Xu, Fang Wang, Xiaohan Fan, Yan Dai, Zhimin Liu, Shu Zhang

ABSTRACT

BackgroundHigh levels of physical activity (PA) and heart rate variability (HRV) are associated with cardiovascular benefits in patients with cardiovascular diseases. HRV, representing cardiac autonomic function, is positively associated with PA. However, the impacts of PA and cardiac autonomic function on cardiovascular outcomes were not analysed in the same study population. This lack of evidence supported our hypothesis that PA might contribute to cardiovascular benefits via enhanced cardiac autonomic function.MethodsPatients with implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy defibrillator (CRT-D) implantation were included from the SUMMIT registry. HRV and PA values were assessed during the first 30–60 days post device implantation using a continuous home monitoring system. Causal mediation analysis was conducted to explore the possible mediation function of HRV in the association of PA with long-term cardiac death and all-cause mortality in patients at a high risk of sudden cardiac death.ResultsOver a mean follow-up period of 47.7 months, 63 cardiac deaths (18.9%) and 85 all-cause death events (25.5%) were observed among 342 patients with ICD/CRT-D implantation. A positive linear association between HRV and PA was demonstrated and the β value of HRV was 0.842 (95% confidence interval [CI]: 0.261–1.425, P = 0.005) in the multiple linear regression analysis. Multivariable Cox proportional hazards analysis revealed that high levels of PA (≥11.0%) and HRV (≥75.9 ms) were independent protective factors against cardiac death (PA: hazard ratio [HR] = 0.273; 95% CI, 0.142–0.526, P < 0.001; HRV: HR = 0.224; 95% CI, 0.103–0.489, P < 0.001) and all-cause mortality (PA: HR = 0.299; 95% CI, 0.177–0.505, P < 0.001; HRV: HR = 0.394; 95% CI, 0.231–0.674, P = 0.001). Causal mediation analysis demonstrated partial mediation effects of PA that were mediated through HRV on cardiac death (mediation proportion = 12.9, 95%CI: 2.2–32.0%, P = 0.006) and all-cause mortality (mediation proportion = 8.2, 95%CI: 1.6–20.0%, P = 0.006).ConclusionsHRV might be a modest mediator in the association between high levels of PA and the reduced risks of cardiac death and all-cause mortality in ICD/CRT-D recipients. This finding supports that enhanced cardiac autonomic function might be one of the underlying mechanisms by which regular PA contributes to cardiovascular benefits. More... »

PAGES

128

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12966-021-01200-0

DOI

http://dx.doi.org/10.1186/s12966-021-01200-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1141248414

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/34544427


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16 schema:description BackgroundHigh levels of physical activity (PA) and heart rate variability (HRV) are associated with cardiovascular benefits in patients with cardiovascular diseases. HRV, representing cardiac autonomic function, is positively associated with PA. However, the impacts of PA and cardiac autonomic function on cardiovascular outcomes were not analysed in the same study population. This lack of evidence supported our hypothesis that PA might contribute to cardiovascular benefits via enhanced cardiac autonomic function.MethodsPatients with implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy defibrillator (CRT-D) implantation were included from the SUMMIT registry. HRV and PA values were assessed during the first 30–60 days post device implantation using a continuous home monitoring system. Causal mediation analysis was conducted to explore the possible mediation function of HRV in the association of PA with long-term cardiac death and all-cause mortality in patients at a high risk of sudden cardiac death.ResultsOver a mean follow-up period of 47.7 months, 63 cardiac deaths (18.9%) and 85 all-cause death events (25.5%) were observed among 342 patients with ICD/CRT-D implantation. A positive linear association between HRV and PA was demonstrated and the β value of HRV was 0.842 (95% confidence interval [CI]: 0.261–1.425, P = 0.005) in the multiple linear regression analysis. Multivariable Cox proportional hazards analysis revealed that high levels of PA (≥11.0%) and HRV (≥75.9 ms) were independent protective factors against cardiac death (PA: hazard ratio [HR] = 0.273; 95% CI, 0.142–0.526, P < 0.001; HRV: HR = 0.224; 95% CI, 0.103–0.489, P < 0.001) and all-cause mortality (PA: HR = 0.299; 95% CI, 0.177–0.505, P < 0.001; HRV: HR = 0.394; 95% CI, 0.231–0.674, P = 0.001). Causal mediation analysis demonstrated partial mediation effects of PA that were mediated through HRV on cardiac death (mediation proportion = 12.9, 95%CI: 2.2–32.0%, P = 0.006) and all-cause mortality (mediation proportion = 8.2, 95%CI: 1.6–20.0%, P = 0.006).ConclusionsHRV might be a modest mediator in the association between high levels of PA and the reduced risks of cardiac death and all-cause mortality in ICD/CRT-D recipients. This finding supports that enhanced cardiac autonomic function might be one of the underlying mechanisms by which regular PA contributes to cardiovascular benefits.
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22 schema:keywords BackgroundHigh levels
23 ConclusionsHRV
24 Cox proportional hazards analysis
25 MethodsPatients
26 PA contributes
27 PA values
28 ResultsOver
29 activity
30 analysis
31 association
32 association of PA
33 autonomic function
34 benefits
35 cardiac autonomic function
36 cardiac death
37 cardiovascular benefits
38 cardiovascular disease
39 cardiovascular outcomes
40 cardioverter defibrillator
41 causal mediation analysis
42 cause death events
43 cause mortality
44 cohort study
45 contributes
46 days
47 death
48 death events
49 defibrillator
50 defibrillator implantation
51 device implantation
52 disease
53 effect
54 events
55 evidence
56 factors
57 findings
58 follow
59 function
60 hazard analysis
61 heart rate variability
62 high levels
63 high risk
64 home monitoring system
65 hypothesis
66 impact
67 impact of PA
68 implantable cardioverter defibrillator
69 implantation
70 independent protective factor
71 lack
72 lack of evidence
73 levels
74 linear association
75 linear regression analysis
76 long-term cardiac death
77 mean follow
78 mechanism
79 mediation analysis
80 mediation effect
81 mediation function
82 mediators
83 modest mediator
84 monitoring system
85 months
86 mortality
87 multiple linear regression analysis
88 multivariable Cox proportional hazards analysis
89 outcomes
90 partial mediation effect
91 patients
92 period
93 physical activity
94 population
95 positive linear association
96 proportional hazards analysis
97 protective factors
98 rate variability
99 registry
100 regression analysis
101 risk
102 same study population
103 study
104 study population
105 sudden cardiac death
106 system
107 values
108 variability
109 β values
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