Short-Term Heart Rate Variability Predicts Sudden Unexpected Death in Epilepsy
Abstract number :
1.105
Submission category :
2. Translational Research / 2C. Biomarkers
Year :
2021
Submission ID :
1826272
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:53 AM
Authors :
Shobi Sivathamboo, PhD - Monash University; Daniel Friedman - New York University Grossman School of Medicine; Juliana Laze - New York University Grossman School of Medicine; Russell Nightscales - Monash University; Zhibin Chen - Monash University; Levin Kuhlmann - Monash University; Sasha Devore - New York University Grossman School of Medicine; Vaughan Macefield - Baker Heart and Diabetes Institute; Patrick Kwan - Monash University; Wendyl D’Souza - St. Vincent’s Hospital; Samuel Berkovic - The University of Melbourne; Piero Perucca - The University of Melbourne; Terence O'Brien - Monash University; Orrin Devinsky - New York University Grossman School of Medicine
Rationale: Aberrant heart rate variability (HRV) strongly predicts sudden death in heart disease patients, but whether it is a risk factor for sudden unexpected death in epilepsy (SUDEP) remains unclear. We compared HRV between SUDEP cases and living epilepsy controls.
Methods: This international, multicenter, nested case-control study analyzed patients admitted for video-EEG monitoring (VEM) between January 1, 2003, and December 31, 2014. Cases subsequently dying of SUDEP and matched living epilepsy controls were identified. Time-domain and frequency-domain components were extracted from five-minute interictal electrocardiogram recordings during sleep and wakefulness from SUDEP cases and controls.
Results: We identified 31 SUDEP cases and 56 living epilepsy controls. Normalized low-frequency power (LFP) during wakefulness was lower in SUDEP cases (median 42.5, IQR 32.6–52.6) than controls (55.5, IQR 40.7–68.9; p=0.015, critical value=0.025; Figure 1). In the multivariable model, normalized LFP was lower in SUDEP cases than controls (contrast -11.01, 95% CI: -20.29–-1.73; p=0.020, critical value=0.025). There was a negative correlation between LFP and survival duration (as measured by the time latency from VEM admission to SUDEP), where each 1% incremental reduction in normalized LFP conferred a 2.7% decrease in the time to SUDEP (95% CI: 0.95–0.995; p=0.017, critical value=0.025). Longer survival duration from VEM admission to SUDEP was associated with higher normalized high-frequency power (HFP; p=0.002, critical value=0.025). The predictive model of normalized LFP in SUDEP cases had a C-statistic of 0.66 (95% CI: 0.55–0.77), which was associated with a small and non-significant increase with the addition of normalized HFP (C-statistic 0.70, 95% CI 0.59–0.81; p=0.209).
Conclusions: Reduced short-term LFP, a validated biomarker for cardiac sudden death, predicts SUDEP. Increased HFP appears to be associated with longer survival and may be cardioprotective in SUDEP. HRV quantification may help stratify individual SUDEP risk. Integration of HRV as a biomarker for SUDEP into multimodal risk-stratification models may help identify patients at greatest SUDEP risk, allowing implementation of targeted interventions to mitigate this risk.
Funding: Please list any funding that was received in support of this abstract.: Finding A Cure for Epilepsy and Seizures (FACES), and the Australian National Health and Medical Research Council (NHMRC).
Translational Research