Deceleration Capacity of the heart rate predicts major adverse cardiac events in the general population: the KORA KMC study

Identifying individuals at high risk for cardiovascular events is increasingly important in an aging population. Deceleration Capacity of the heart rate (DC), an autonomic parameter developed from long-term ECG recordings in myocardial infarction survivors, reflects the heart’s capacity to decelerate. It is a strong and independent predictor of all-cause mortality in cardiac patients and in the general population. Its predictive power for major adverse cardiovascular events (MACE) remains unexplored. This study evaluates the potential of Deceleration Capacity as an automated, non-invasive tool for MACE risk stratification using scalable brief 5-minute ECG recordings in a representative general population sample.

Within the KORA KMC study conducted in southern Germany, 769 participants aged 63 (IQR 56 - 69) years (females 48.8 %), were followed for a median of 13.4 years. The primary endpoint was MACE, defined as a combination of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death. Deceleration Capacity was derived from 5-minute 12-lead ECG using a fully automated approach. A competing risk time to event analysis clearly demonstrates that Deceleration Capacity can identify individuals at low, intermediate, and high risk for MACE (X²=47.6, p<0.001). In a multivariable Cox proportional hazards model, the high-risk group (DC ≤ 2.5 ms) was associated with a 2.57-fold increased MACE-risk (95%-CI 1.58 – 4.18; p <0.001).

In summary, this is the first study demonstrating the predictive power of Deceleration Capacity regarding MACE endpoints. We advocate for the integration of Deceleration Capacity, automatically derived from scalable short-term electrocardiograms, in future screening programs for the general population.