Risk stratification after acute myocardial infarction by heart rate turbulence
Petra Barthel1, Raphael Schneider, Axel Bauer
11 Medizinische Klinik der Technischen Universität München, Ismaninger Strabetae 22, 81675 München, Germany.
Insights
Heart rate turbulence (HRT) is a strong predictor of death after myocardial infarction. Patients with abnormal HRT patterns face a significantly higher risk of mortality in the reperfusion era.
Area of Science:
- Cardiology
- Clinical Medicine
- Predictive Analytics
Background:
- Previous studies indicated that reduced heart rate turbulence (HRT) is linked to increased mortality risk post-myocardial infarction.
- This prospective study is the first to validate HRT's predictive value in a large patient cohort during the reperfusion era.
Purpose of the Study:
- To prospectively evaluate the predictive value of heart rate turbulence (HRT) for all-cause mortality in survivors of acute myocardial infarction.
- To compare HRT's predictive power against established risk factors like left ventricular ejection fraction (LVEF), age, and diabetes mellitus.
Main Methods:
- One thousand four hundred fifty-five acute myocardial infarction survivors (age <76, sinus rhythm) were enrolled.
- Heart rate turbulence onset (TO) and slope (TS) were calculated from Holter recordings.
- Patients were categorized into HRT groups: category 0 (normal TO/TS), category 1 (abnormal TO or TS), and category 2 (abnormal TO and TS).
Main Results:
- During 22 months follow-up, 70 deaths occurred.
- HRT category 2 was the strongest predictor of death (HR=5.9), followed by LVEF ≤30% (HR=4.5), diabetes (HR=2.5), age ≥65 (HR=2.4), and HRT category 1 (HR=2.4).
- Combined risk factor models showed varying sensitivity and positive predictive accuracy for mortality prediction.
Conclusions:
- Heart rate turbulence (HRT) serves as a significant independent predictor of mortality in the post-myocardial infarction population within the reperfusion era.
- HRT provides valuable prognostic information beyond traditional risk factors like LVEF, age, and diabetes.
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.
Methods And 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.
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