title: Postextrasystolic blood pressure potentiation predicts poor outcome of cardiac patients.
abstract: BACKGROUND
  Postextrasystolic blood pressure potentiation (PESP), the pulse wave augmentation after an extrasystolic beat, is typically enhanced in heart failure (HF) patients. This study prospectively tested the association of PESP and mortality in cardiac patients.
  
  
  RESULTS
  Consecutive patients (n=941; mean age, 61 years; 19% female) presenting with acute myocardial infarction were enrolled between May 2000 and March 2005 and followed up until August 2010. The main study outcome was 5-year all-cause mortality. Patients underwent noninvasive 30-minute recordings of ECG and continuous blood pressure. PESP presence was based on the ratio between the first postectopic pulse wave amplitude and the mean of the subsequent 9 pulse wave amplitudes. A ratio above 1 was prospectively defined as PESP present. Ventricular premature complexes (VPCs) suitable for PESP quantification were present in recordings of 220 patients. PESP was present in 62 of these patients. Patients without suitable VPCs were classified as PESP absent.During the follow-up, 72 patients died. Among the 220 patients in whom PESP was measurable, 27 died. Under univariable analysis, PESP was a significant predictor of death (P<0.001) as were GRACE score (P<0.001), left ventricular ejection fraction (LVEF) (P<0.001), and the number of recorded VPCs (P<0.001). Under multivariable analysis, PESP (P<0.001), GRACE score (P<0.001), and LVEF (P=0.001) were independently associated with outcome. The combination of PESP presence and LVEF ≤ 35% identified a subgroup of patients with a particularly high mortality of 46.7%. Separate validation reproduced the finding in an unrelated population of 146 HF patients.
  
  
  CONCLUSIONS
  PESP, which likely reflects abnormalities of myocardial calcium cycling, predicts the mortality risk in postinfarction patients.
  
  
  BACKGROUND
  ClinicalTrials.gov. Unique identifier: NCT00196274.
authors.affiliation: Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Sinnecker
authors.affiliation: Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.).
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Dirschinger
authors.affiliation: Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.).
authors.forename: Petra
authors.initials: P
authors.lastname: Barthel
authors.affiliation: Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Müller
authors.affiliation: Department of Cardiology, University Hospital of North Staffordshire, NHS Trust, City General Hospital, Staffordshire, UK (A.M.D.).
authors.forename: Adrian
authors.initials: A
authors.lastname: Morley-Davies
authors.affiliation: Institut für Medizinische Statistik und Epidemiologie der Technischen, Universität München, Munich, Germany (A.H.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Hapfelmeier
authors.affiliation: Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.).
authors.forename: Michael
authors.initials: M
authors.lastname: Dommasch
authors.affiliation: Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.).
authors.forename: Katharina M
authors.initials: KM
authors.lastname: Huster
authors.affiliation: Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany (G.H.).
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuss
authors.affiliation: Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.) DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (K.L.L., G.S.).
authors.forename: Karl-Ludwig
authors.initials: KL
authors.lastname: Laugwitz
authors.affiliation: St. Paul's Cardiac Electrophysiology, University of London and Imperial College, London, UK (M.M.).
authors.forename: Marek
authors.initials: M
authors.lastname: Malik
authors.affiliation: Medizinische Klinik und Deutsches Herzzentrum, München der Technischen Universität München, Munich, Germany (D.S., R.J.D., P.B., A., M.D., K.M.H., K.L.L., G.S.) DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany (K.L.L., G.S.).
authors.forename: Georg
authors.initials: G
authors.lastname: Schmidt
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D005117:Cardiac Complexes, Premature / Q000401:mortality / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology*; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D018879:Ventricular Premature Complexes / Q000401:mortality / Q000503:physiopathology
keywords: calcium cycling; myocardial infarction; risk assessment