Prognostic role of heart rate variability in patients with a recent acute myocardial infarction

A low heart rate variability (HRV) has been shown to be a powerful predictor of cardiac events in patients surviving an acute myocardial infarction (MI), but it is not clear yet which among the HRV parameters has the best predictive value. Time domain and frequency domain HRV was assessed on 24-hour...

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Bibliographic Details
Published in:The American journal of cardiology 1998-12, Vol.82 (11), p.1323-1328
Main Authors: Lanza, Gaetano Antonio, Guido, Vincenzo, Galeazzi, M.Marco, Mustilli, Marina, Natali, Rosaria, Ierardi, Carolina, Milici, Caterina, Burzotta, Francesco, Pasceri, Vincenzo, Tomassini, Francesco, Lupi, Alessandro, Maseri, Attilio
Format: Article
Language:English
Subjects:
Aged
Analysis of Variance
Biological and medical sciences
Cardiology
Death, Sudden, Cardiac
Electrocardiography, Ambulatory
Electrocardiography. Vectocardiography
Electrodiagnosis. Electric activity recording
Female
Follow-Up Studies
Heart Rate
Humans
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical research
Medical sciences
Middle Aged
Myocardial Infarction - mortality
Myocardial Infarction - physiopathology
Predictive Value of Tests
Prognosis
Stroke Volume
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Summary:A low heart rate variability (HRV) has been shown to be a powerful predictor of cardiac events in patients surviving an acute myocardial infarction (MI), but it is not clear yet which among the HRV parameters has the best predictive value. Time domain and frequency domain HRV was assessed on 24-hour predischarge Holter recording of 239 patients with a recent MI. Patients were followed up for 6 to 54 months (median 28), during which 26 deaths (11%) occurred, 19 of which were cardiac in origin and 12 were sudden. Most HRVs did not show any difference between patients with or without mortality end points, but the average low-frequency and low-frequency/high-frequency ratio was lower in patients with events. However, when dichotomized according to cut points that maximized the risk of sudden death, several HRVs were significantly predictive of clinical end points. Overall, the mean of the standard deviations of all RR intervals for all 5-minute segments and the standard deviation of the mean RR intervals for all 5-minute segments were the time domain variables most significantly associated with mortality end points, whereas very low frequency was the most predictive frequency domain variable. Compared with the best time domain variables, very low frequency showed a better sensitivity (0.27 to 0.42 vs 0.19 to 0.33) for end points with only a small loss in specificity (0.92 vs 0.96). On multivariate Cox proportional analysis, a left ventricular ejection fraction
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(98)00635-3