Critical value of baroreflex sensitivity determined by spectral analysis in risk stratification after myocardial infarction.
The risk of cardiac death in patients after MI is predicted by a decreased baroreflex sensitivity (BRS). The critical value of BRS based on phenylephrine administration is 3 ms/mmHg. The aim of this study was to determine the critical value of BRS assessed by spectral analysis of spontaneous fluctuations in pulse intervals and blood pressure. Digital blood pressure was recorded noninvasively (3 min, controlled breathing 0.33 Hz) in 112 patients, 8-18 days after MI. Nine patients died during the first year after MI. BRS was determined as the gain between the spectrum of the variability of systolic blood pressure and the cross-spectrum between the variability of pulse intervals and systolic blood pressure. The gain at the frequency of 0.1 Hz was taken as the measure of BRS. Sensitivity, specificity, and the positive predictive value were calculated in the range of 1-10 ms/mmHg in steps of 1 ms/mmHg. The value of BRS above which sensitivity no longer increases and specificity decreases was taken as the optimal value. The critical value of BRS determined by spectral analysis was 3 ms/mmHg (sensitivity 77%; specificity 71%). In conclusion, the spectral critical value of BRS determined by spectral analysis of spontaneous fluctuations in pulse intervals and blood pressure corresponds to the value determined by the phenylephrine method.
Honzikova
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Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic. nhonziko@med.muni.cz
Fiser
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D017704:Baroreflex; D001794:Blood Pressure; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D015996:Survival Rate