title: Risk stratification after acute myocardial infarction by heart rate turbulence.
abstract: BACKGROUND
  Retrospective postinfarction studies revealed that decreased heart rate turbulence (HRT) indicates increased risk for subsequent death. This is the first prospective study to validate HRT in a large cohort of the reperfusion era.
  
  
  RESULTS
  One thousand four hundred fifty-five survivors of an acute myocardial infarction (age <76 years) in sinus rhythm were enrolled. HRT onset (TO) and slope (TS) were calculated from Holter records. Patients were classified into the following HRT categories: category 0 if both TO and TS were normal, category 1 if either TO or TS was abnormal, or category 2 if both TO and TS were abnormal. The primary end point was all-cause mortality. During a follow-up of 22 months, 70 patients died. Multivariately, HRT category 2 was the strongest predictor of death (hazard ratio, 5.9; 95% CI, 2.9 to 12.2), followed by left ventricular ejection fraction (LVEF) < or =30% (4.5; 2.6 to 7.8), diabetes mellitus (2.5; 1.6 to 4.1), age > or =65 years (2.4; 1.5 to 3.9), and HRT category 1 (2.4; 1.2 to 4.9). LVEF < or =30% had a sensitivity of 27% at a positive predictive accuracy level of 23%. The combined criteria of LVEF < or =30%, HRT category 2 or LVEF >30%, age > or =65 years, diabetes mellitus, and HRT category 2 had a sensitivity of 24% at a positive predictive accuracy level of 37%. The combined criteria of LVEF < or =30% or LVEF >30%, age > or =65 years, diabetes mellitus, and HRT category 1 or 2 had a sensitivity of 44% at a positive predictive accuracy level of 23%.
  
  
  CONCLUSIONS
  HRT is a strong predictor of subsequent death in postinfarction patients of the reperfusion era.
authors.affiliation: 1 Medizinische Klinik der Technischen Universität München, Ismaninger Strabetae 22, 81675 München, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Barthel
authors.forename: Raphael
authors.initials: R
authors.lastname: Schneider
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
authors.forename: Kurt
authors.initials: K
authors.lastname: Ulm
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.forename: Georg
authors.initials: G
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D001794:Blood Pressure; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality / Q000503:physiopathology; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017741:Survivors / Q000706:statistics & numerical data; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000503:physiopathology