Predictors of long-term risk for heart failure hospitalization after acute myocardial infarction.
BACKGROUND
Data on the value of baseline brain natriuretic peptide (BNP) and autonomic markers in predicting heart failure (HF) hospitalization after an acute myocardial infarction (AMI) are limited.


METHODS
A consecutive series of patients with AMI without a previous history of HF (n = 569) were followed up for 8 years. At baseline, the patients had a blood sample for determination of BNP, a 24-hour Holter recording for evaluating heart rate variability (HRV) and heart rate turbulence (HRT), and an assessment of baroreflex sensitivity (BRS) using phenylephrine test.


RESULTS
During the follow-up, 79 (14%) patients were hospitalized due to HF. Increased baseline BNP, decreased HRV, HRT, and BRS had a significant association with HF hospitalization in univariate comparisons (P < 0.001 for all). After adjusting with all the relevant clinical parameters, BNP, HRV, and HRT still significantly predicted HF hospitalization (P < 0.001 for BNP and for the short-term scaling exponent alpha(1), P < 0.01 for turbulence slope). In the receiver operator characteristics curve analysis, the area under the curve for BNP was 0.77, for the short-term scaling exponent alpha(1) 0.69, for turbulence slope 0.71, and for BNP/standard deviation of all N-N intervals ratio 0.80.


CONCLUSIONS
Baseline increased BNP and impaired autonomic function after AMI yield significant information on the long-term risk for HF hospitalization.
Perkiömäki
Juha S
JS
Department of Medicine, University of Oulu, Finland. juha.perkiomaki@oulu.fi
Hämekoski
Sari
S
Junttila
M Juhani
MJ
Jokinen
Vesa
V
Tapanainen
Jari
J
Huikuri
Heikki V
HV
D000208:Acute Disease; D000368:Aged; D017704:Baroreflex; D015415:Biomarkers / Q000097:blood; D015984:Causality; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology*; D006339:Heart Rate; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain