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Prognostic value of left ventricular diastolic function and association with heart rate variability after a first
S H Poulsen1, S E Jensen, J E Møller
1Department of Internal Medicine, Section of Cardiology, Haderslev Sygehus, Denmark. steen.hvitfeldt@dadlnet.dl
Insights
Restrictive left ventricular filling after myocardial infarction is a strong predictor of adverse outcomes. This pattern is associated with reduced heart rate variability (HRV), indicating impaired autonomic balance post-MI.
Area of Science:
- Cardiology
- Clinical Medicine
- Physiology
Background:
- Acute myocardial infarction (MI) can lead to significant cardiac dysfunction.
- Left ventricular (LV) diastolic function and heart rate variability (HRV) are important indicators of cardiac health post-MI.
- Understanding the interplay between LV diastolic function and autonomic balance (HRV) is crucial for prognosis.
Purpose of the Study:
- To investigate the prognostic significance of LV diastolic function in patients following their first acute MI.
- To examine the relationship between LV diastolic function and autonomic balance, as assessed by HRV.
- To identify predictors of adverse cardiac events after first acute MI.
Main Methods:
- Sixty-four patients with first acute MI and 31 controls were studied.
- 24-hour Holter monitoring assessed long and short-term HRV indices.
- Two-dimensional and Doppler echocardiography evaluated LV systolic and diastolic function.
- Patients were classified based on mitral deceleration time (restrictive vs. non-restrictive filling).
Main Results:
- Patients with restrictive LV filling exhibited significantly reduced HRV compared to non-restrictive and control groups.
- Mitral deceleration time and isovolumetric relaxation time showed significant correlations with HRV indices.
- Multivariate analysis identified mitral deceleration time and ejection fraction ≤40% as independent predictors of cardiac death and heart failure readmission.
Conclusions:
- Restrictive LV filling pattern is the strongest independent predictor of adverse outcomes after first acute MI.
- Patients with restrictive LV filling have more impaired HRV, suggesting a link between diastolic dysfunction and autonomic imbalance.
- Ejection fraction also remains a significant predictor of adverse events.
Objective:
To study the prognostic value of left ventricular (LV) diastolic function and its relation with autonomic balance expressed by heart rate variability (HRV) in patients after a first acute myocardial infarction.
Design:
The study population consisted of 64 consecutive patients with first acute myocardial infarction and 31 control subjects. Long and short term HRV indices were evaluated by 24 hour Holter monitoring, and LV systolic and diastolic function were assessed by two dimensional and Doppler echocardiography before discharge. Patients were divided into two groups: those with restrictive LV filling characteristics (deceleration time 140 ms).
Results:
Both long and short term HRV indices were significantly reduced in patients with restrictive LV filling compared with the non-restrictive group and control subjects. Mitral deceleration time and isovolumetric relaxation time correlated weakly but significantly with all indices of HRV whereas ejection fraction correlated weakly with the long term HRV indices. The mean follow up time was 14.9 (8.7) months. Multivariate analysis showed that mitral deceleration time (chi(2) = 6.4, p < 0.001) and ejection fraction
Conclusions:
A restrictive LV filling pattern was found to be the strongest predictor of adverse outcome independent of HRV and ejection fraction during follow up after a first acute myocardial infarction. Patients with restrictive LV filling characteristics had more reduced HRV than those with non-restrictive diastolic filling.