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Prognostic value of heart rate variability in post-infarction patients
Insights
Depressed heart rate variability (HRV) is a significant predictor of mortality in patients after acute myocardial infarction (AMI). Lower HRV values indicate a higher risk of death, aiding in patient risk stratification.
Area of Science:
- Cardiology
- Medical Prognostics
- Autonomic Nervous System Research
Background:
- Autonomic disequilibrium, indicated by depressed heart rate variability (HRV), is linked to ventricular ectopy and risk stratification in acute myocardial infarction (AMI) patients.
- Assessing HRV's predictive value for all-cause mortality in post-infarction individuals is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate heart rate variability (HRV) as a prognostic indicator for all-cause mortality in patients following an acute myocardial infarction (AMI).
Main Methods:
- Analysis of 24-hour electrocardiographic (ECG) recordings from 100 post-MI patients.
- Time-domain HRV analysis, including standard deviation of normal-to-normal intervals (SDNN), RRmax-RRmin, and mean RR interval, performed 8-13 days post-infarction.
- Assessment of ventricular premature complexes, clinical evaluation, laboratory tests, and echocardiography.
Main Results:
- Within one year, 11 patients died (10 cardiac, 1 stroke).
- Deceased patients exhibited significantly lower SDNN, RRmax-RRmin, and mean RR interval compared to survivors (p < 0.01).
- Independent predictors of mortality included depressed HRV (SDNN), advanced heart failure (Killip class II/III), and ventricular ectopic activity.
Conclusions:
- Reduced heart rate variability (HRV) independently predicts mortality in post-infarction patients.
- HRV analysis offers valuable, non-invasive prognostic information for risk stratification in this population.
Background/Aim:
Depressed heart rate variability (HRV) indicating autonomic disequilibrium and propensity to ventricular ectopy can be useful for risk stratification in patients following acute myocardial infarction (AIM). The aim of the study was to assess heart rate variability as a predictor of all-cause mortality in post-infarction patients.
Methods:
We analyzed the 24-hour electrocardiographic (ECG) recordings of 100 patients (80 males) during hospitalization for
Aim:
The mean age of patients was 56.99 + 11.03 years. Time domain heart rate variability analysis was obtained from 8 to 13 days after index infarction by mean of a 24-hour ECG recording, and the calculated parameters were: standard deviation of all normal to normal RR intervals (SDNN), RRmax-RRmin (difference between the longest RR interval and the shortest RR interval), mean RR interval. We also analyzed ventricular premature complexes from the ECG data. The patients underwent clinical evaluation, laboratory tests and echocardiography.
Results:
Within a one-year follow-up period 11 patients experienced death, 10 of them because of cardiac reason and one because of stroke. There were significantly lower values of SDNN (60.55 ± 12.84 ms vs 98.38 ± 28.21 ms), RRmax-RRmin (454.36 ± 111.00 ms vs 600.99 ± 168.72 ms) and mean RR interval (695.82 ± 65.87 ms vs 840.07 ± 93.97 ms) in deceased patients than in the survivors, respectively (p < 0.01). The deceased patients were of higher mean age, with lower left ventricular ejection fraction (0.46 ± 0.05 vs 0.56 ± 0.06 in survivors), and more frequent clinical signs of heart failure and ventricular ectopic activity (> 10VPCs/h; p < 0.01). Multivariate Cox analysis showed that SDNN was a significant, independent predictor of all-cause mortality in post-infarction patients. The other independent predictors were clinical signs of heart failure--Killip class II and III and ventricular ectopic activity.
Conclusion:
Depressed HRV is an independent predictor of mortality in post-infarction patients and may provide useful additional prognostic information in non-invasive risk stratification of these patients.
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