title: Predictors of long-term risk for heart failure hospitalization after acute myocardial infarction.
abstract: 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.
authors.affiliation: Department of Medicine, University of Oulu, Finland. juha.perkiomaki@oulu.fi
authors.forename: Juha S
authors.initials: JS
authors.lastname: Perkiömäki
authors.forename: Sari
authors.initials: S
authors.lastname: Hämekoski
authors.forename: M Juhani
authors.initials: MJ
authors.lastname: Junttila
authors.forename: Vesa
authors.initials: V
authors.lastname: Jokinen
authors.forename: Jari
authors.initials: J
authors.lastname: Tapanainen
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
mesh_terms: 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
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain