Assessment of heart rate turbulence in the acute phase of myocardial infarction for long-term prognosis.
This study is designed to assess the value of heart rate turbulence (HRT) in the acute phase of MI for prediction of long-term mortality risk. The study included 128 consecutive acute MI patients with 24-hour Holter recordings to evaluate HRT (turbulence onset and slope), SDNN, mean RR interval, and ventricular premature beat frequency. LVEF was evaluated by two-dimensional echocardiography. Data from 117 patients (mean age 58 +/- 11 years) were available for further analysis. Twelve patients died during follow-up (mean 312 +/- 78 days). Although SDNN < 70 ms was the most powerful predictor of mortality among all presumed risk factors (hazard ratio 20 [95% CI 2.6-158]; P = 0.004) in univariate Cox regression analysis, in multivariate analysis LVEF < or = 0.40 and turbulence slope < or = 2.5 ms/RR interval were the only independent predictors of mortality (hazard ratio 6.9 [95% CI 1.8-26]; P = 0.006, hazard ratio 7.3 [95% CI 1.4-37]; P = 0.016, respectively). Addition of HRT parameters for LVEF increased remarkably the positive predictive value (60%) without any decrease in the negative predictive value (92%). Blunted HRT reaction within the first 24 hours of acute MI is an independent predictor of long-term mortality. Furthermore, its predictive power is comparable and also additive to that of LVEF.
Sade
Elif
E
Hacettepe University School of Medicine, Department of Cardiology, Ankara, Turkey. sadele@msx.upmc.edu
Aytemir
Kudret
K
Oto
Ali
A
Nazli
Nash
N
Ozmen
Ferhan
F
Ozkutlu
Hilmi
H
Tokgözoglu
Lale
L
Aksöyek
Serdar
S
Ovünç
Kenan
K
Kabakçi
Giray
G
Ozer
Necla
N
Kes
Sirri
S
D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D018879:Ventricular Premature Complexes / Q000453:epidemiology / Q000503:physiopathology