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Risk stratification after acute myocardial infarction by amplitude-frequency mapping of cyclic variation of heart

Junichiro Hayano1, Norihiro Ueda1, Masaya Kisohara1

  • 1Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|February 2, 2021
PubMed

Insights

Reduced heart rate variation predicts mortality after heart attack. Incorporating sleep apnea severity improves this prediction, enhancing risk assessment for patients post-acute myocardial infarction (AMI).

Area of Science:

  • Cardiology
  • Sleep Medicine
  • Data Science

Background:

  • Blunted cyclic variation of heart rate (CVHR) amplitude (Acv) predicts mortality post-acute myocardial infarction (AMI).
  • Mild sleep apnea with mild O2 desaturation can also reduce Acv.
  • The study investigates if sleep apnea severity influences Acv's predictive power for post-AMI mortality.

Purpose of the Study:

  • To enhance the predictive accuracy of Acv for mortality risk after AMI.
  • To evaluate the impact of sleep apnea severity on Acv's prognostic value.
  • To develop a method for adjusting Acv based on sleep apnea severity.

Main Methods:

  • Utilized 24-hr ECG data from 265,291 participants in the Allostatic State Mapping by Ambulatory ECG Repository (ALLSTAR) project.
  • Estimated sleep apnea severity using the frequency of CVHR (Fcv) via an automated ACAT algorithm.
  • Modeled Acv distribution against Fcv using percentile regression and developed a function to convert Acv to a percentile value.

Main Results:

  • Low Acv values were more prevalent with lower Fcv in ALLSTAR data.
  • In the ENRICHD cohort (673 survivors, 44 non-survivors post-AMI), logistic regression showed improved c-statistics for mortality prediction: Fcv (0.667), unadjusted Acv (0.817), and percentile Acv (0.843).
  • Percentile Acv demonstrated a significant net reclassification improvement of 0.90 (95% CI, 0.51-1.42) compared to unadjusted Acv.

Conclusions:

  • The predictive power of Acv for post-AMI mortality is significantly improved by considering its relationship with sleep apnea severity, estimated by Fcv.
  • A novel percentile-based Acv calculation enhances prognostic accuracy.
  • This approach offers a more refined risk stratification for post-myocardial infarction patients potentially affected by sleep apnea.
Abstract

Keywords:
ALLSTARcyclic variation of heart rateheart rate variabilitymortalitymyocardial infarctionsleep apnea

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