Baroreflex sensitivity but not microvolt T-wave alternans can predict major adverse cardiac events in ischemic heart
Damian K Kaufmann1, Grzegorz Raczak2, Małgorzata Szwoch2
1Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland. pestkowy@gmail.com.
Insights
Baroreflex sensitivity (BRS) and left ventricular ejection fraction (LVEF) independently predict major adverse cardiovascular events (MACE) in ischemic heart failure patients. Low BRS (≤ 3 ms/mmHg) and LVEF (≤ 33%) indicate the highest MACE risk.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Heart Failure Management
Background:
- Major adverse cardiovascular events (MACE) are a primary cause of mortality in ischemic heart failure (HF).
- The prognostic value of autonomic nervous system parameters and microvolt T-wave alternans (MTWA) in HF patients remains unclear.
- This study aimed to evaluate these parameters for MACE prediction in ischemic HF with left ventricular systolic dysfunction.
Purpose of the Study:
- To assess the predictive value of baroreflex sensitivity (BRS) and microvolt T-wave alternans (MTWA) for MACE in ischemic heart failure patients.
- To identify independent predictors of MACE in this population.
- To establish cut-off values for key parameters associated with MACE risk.
Main Methods:
- Analysis of BRS, heart rate variability (HRV), MTWA, and clinical data in 188 ischemic HF outpatients (LVEF ≤ 50%).
- Follow-up duration of 34 months (range 14-71) with endpoint recording.
- Univariate and multivariate Cox regression analyses to identify MACE predictors.
Main Results:
- Univariate analysis identified BRS, MTWA, age, NYHA class III, LVEF, ICD presence, diuretic/antiarrhythmic use, diabetes, and kidney insufficiency as MACE predictors.
- Multivariate analysis confirmed BRS (HR 2.97) and LVEF (HR 1.98) as independent predictors.
- Significant cut-off values were BRS ≤ 3 ms/mmHg and LVEF ≤ 33%.
Conclusions:
- BRS and LVEF are independent predictors of MACE in ischemic HF patients with LVEF ≤ 50%.
- Specific thresholds (BRS ≤ 3 ms/mmHg, LVEF ≤ 33%) identify patients at highest risk for MACE.
- These findings aid in risk stratification and management of ischemic heart failure.
Background:
Major adverse cardiovascular events (MACE) constitutes the main cause of morbidity and mortality in ischemic heart failure (HF) patients. The prognostic value of the autonomic nervous system parameters and microvolt T-wave alternans (MTWA) in this issue has not been identified to date. The aim herein, was to assess the usefulness of the abovementioned parameters in the prediction of MACE in HF patients with left ventricular systolic dysfunction of ischemic origin.
Methods:
Baroreflex sensitivity (BRS), heart rate variability (HRV), MTWA and other well-known clinical parameters were analyzed in 188 ischemic HF outpatients with left ventricular ejection fraction (LVEF) ≤ 50%. During 34 (14-71) months of follow-up, 56 (30%) endpoints were noted.
Results:
Univariate Cox analyses revealed BRS (but not HRV), MTWA, age, New York Heart Association functional class III, LVEF, implantable cardioverter-defibrillator presence, use of diuretics and antiarrhythmic drugs, diabetes, and kidney insufficiency were defined as significant predictors of MACE. Pre-specified cut-off values for MACE occurrence for the aforementioned continuous parameters (age, LVEF, and BRS) were: ≥ 72 years, ≤ 33%, and ≤ 3 ms/mmHg, respectively. In a multivariate Cox analysis only BRS (HR 2.97, 95% CI 1.35-6.36, p < 0.006), and LVEF (HR 1.98, 95% CI 0.61-4.52, p < 0.038) maintained statistical significance in the prediction of MACE.
Conclusions:
Baroreflex sensitivity and LVEF are independent of other well-known clinical parameters in the prediction of MACE in patients with HF of ischemic origin and LVEF up to 50%. BRS ≤ 3 ms/mmHg and LVEF ≤ 33% identified individuals with the highest probability of MACE during the follow-up period.
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