Deceleration capacity of the heart rate derived from short-term ECG recordings predicts mortality in the general population: the KORA study

Julia Allescher (München)1, P. Barthel (München)1, A. Müller (München)1, B. Linkohr (Neuherberg)2, I.-M. Rückert-Eheberg (Neuherberg)2, E. Martens (München)1, A. Peters (Neuherberg)2, G. Schmidt (München)1, A. Steger (München)1

1Klinikum rechts der Isar der Technischen Universität München Klinik und Poliklinik für Innere Medizin I München, Deutschland; 2Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH) Epidemiologie Neuherberg, Deutschland



With the ageing of our civilisation and the increasing burden of chronic disease, risk stratification of the general population with the aim of improving overall health outcomes and reducing healthcare costs has become an essential area of modern medicine. Heart rate deceleration capacity is an autonomic parameter that quantifies vagal effects on heart rate modulation. Derived from long-term ECG recordings, it is an established predictor of mortality in survivors of myocardial infarction. The aim of this study was to derive Deceleration Capacity from scalable short-term ECG recordings of five minutes duration and to validate it as an independent long-term predictor of mortality risk in the general population.

Methods and Findings:

We included 823 participants from a large German population-based cohort study (KORA, Cooperative Health Research in the Region of Augsburg) who were followed for a median of 13.4 years. A 5-minute 12-lead resting ECG was obtained from all participants at enrolment. Deceleration capacity was derived from these ECGs using the phase-rectified signal averaging method. ROC curves were calculated for the prediction of all-cause mortality, and with an AUC of 0.69 (p < 0.001), Deceleration Capacity was confirmed as a strong risk predictor in the KORA KMC cohort. Multivariable Cox proportional hazards models were performed and confirmed deceleration capacity as a strong and independent predictor of mortality risk. Using three predefined Deceleration Capacity risk categories, Kaplan-Meier survival curves were calculated, identifying a majority of individuals at low risk of death, a smaller group at intermediate risk, and a minority of participants at substantially increased risk of death.


The results of this study confirm that (a) Deceleration Capacity can be derived from scalable 5-minute electrocardiogram recordings and that (b) it is an independent and strong predictor of long-term mortality in the general population.

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