Heart failure & cardiomyopathiesCohort study
Skin sympathetic nerve activity complexity predicts sudden and nonsudden cardiac mortality in heart failure
- Cohort analysis of ECG recordings (MUerte Subita en Insuficiencia Cardiaca dataset)
- multivariable Cox models
Authors' conclusion
rSKNA complexity measures, particularly MSE, provide complementary, noninvasive prognostic information for sudden and nonsudden CD in HF beyond established clinical predictors and HRV.
Study context
- Population
- Patients with heart failure (HF) in the MUerte Subita en Insuficiencia Cardiaca dataset, excluding device carrierspatients with HF after excluding device carriers
- Participants
- 588 patients
- Exposure
- Raw SKNA (rSKNA) complexity measures (Lyapunov exponent (LE), multiscale entropy (MSE)) vs amplitude-based SKNA metrics and heart rate variability (HRV) indices for prediction of cardiac death (CD)
Main finding
As reported in the abstract
Moving average-/root mean square-based SKNA metrics
- Did not show consistent between-group differences
Observational data: associations, not effects.
Further findings
| Outcome | hazard ratio | P value |
|---|---|---|
| Association of LE and MSE with CD · adjusted Cox models; independently associated | ≈0.75-0.80 | P < 0.05 |
- Association of LE and MSE with CD: adjusted for age, body mass index, left ventricular ejection fraction, New York Heart Association class, diabetes, and previous myocardial infarction
rSKNA complexity measures (LE and MSE)
- Lower in patients who experienced CD (sudden and nonsudden)
HRV indices (standard deviation of normal-to-normal interval, low-frequency power to high-frequency power ratio)
- Not independently associated with CD
Original publication
Skin sympathetic nerve activity complexity predicts sudden and nonsudden cardiac mortality in heart failure. Heart Rhythm. Published 26 February 2026. doi:10.1016/j.hrthm.2026.02.029
Summarised from the published abstract; every number is checked against it