Ultra-short-term heart rate variability for early risk stratification following acute ST-elevation myocardial
Erez Karp1, Arthur Shiyovich, Doron Zahger
1Soroka University Medical Center, Beer Sheva, Israel.
Insights
Early heart rate variability (HRV) measurement in ST-elevation myocardial infarction (STEMI) patients predicts mortality. Reduced HRV on admission ECG is an independent risk factor for 2-year mortality.
Area of Science:
- Cardiology
- Clinical Electrophysiology
- Predictive Analytics in Medicine
Background:
- ST-elevation myocardial infarction (STEMI) is a critical cardiovascular event.
- Prognostic markers are essential for risk stratification and patient management post-STEMI.
- Early assessment of cardiac autonomic function may offer valuable prognostic insights.
Purpose of the Study:
- To determine the prognostic value of ultra-short-term heart rate variability (HRV) measured early during admission for STEMI.
- To assess if HRV parameters correlate with mortality and other cardiovascular outcomes.
- To identify HRV as an independent predictor of adverse events in STEMI patients.
Main Methods:
- Retrospective analysis of 10-second ECGs from 196 consecutive STEMI patients.
- Calculation of heart rate variability (HRV) using standard deviation of N-N intervals (SDNN).
- Definition of reduced HRV as SDNN <9.5 (25th percentile); follow-up for 2 years post-discharge.
Main Results:
- Admission SDNN was significantly lower than discharge SDNN (p=0.001).
- Both admission and discharge SDNN correlated positively with survival (p<0.05).
- Reduced admission SDNN (<9.5) independently predicted 2-year all-cause mortality (OR=2.9, p=0.028).
Conclusions:
- Ultra-short-term HRV, assessed via admission ECG, is a significant predictor of mortality in STEMI patients.
- Reduced HRV is an independent risk factor for long-term mortality following STEMI.
- Early HRV measurement offers a valuable, non-invasive tool for prognostication in STEMI management.
Objectives:
To evaluate the prognostic significance of early ultra-short-term heart rate variability (HRV) measurement in patients admitted for ST-elevation myocardial infarction (STEMI).
Methods:
HRV was calculated retrospectively from the standard admission and discharge 10-second ECG of 196 consecutive patients with STEMI. Reduced HRV was defined as standard deviation of N-N intervals (SDNN) <9.5 (25th percentile). Data regarding all end points were obtained 2 years after discharge for all patients.
Results:
Patients' age was 60.9 +/- 13 years and 21% were female. Admission SDNN was lower than discharge SDNN (20.2 +/- 18 vs. 34.2 +/- 31.1, respectively; p = 0.001). Admission and discharge SDNN positively correlated with survival (r = 0.16, p = 0.03 and r = 0.15, p = 0.04, respectively), but were not predictive of other cardiovascular end points. Reduced admission SDNN was associated with increased mortality at 1 and 6 months, and 1 and 2 years after admission, while discharge SDNN was associated only with 1- and 2-year mortality. Using multivariate analysis, adjusted for potential confounders, admission SDNN <9.5 was found to be an independent risk factor for 2-year mortality (odds ratio = 2.9, 95% confidence interval = 1.12-7.56; p = 0.028).
Conclusions:
Reduced HRV, recorded from admission and discharge ECG, appears to be a significant and independent predictor of all-cause mortality in patients with STEMI.
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