Predictors of Long-Term Risk for Heart Failure Hospitalization after Acute Myocardial Infarction

• Published in: Annals of noninvasive electrocardiology 2010-07, Vol.15 (3), p.250-258
• Main Authors: Perkiömäki, Juha S., Hämekoski, Sari, Junttila, M. Juhani, Jokinen, Vesa, Tapanainen, Jari, Huikuri, Heikki V.
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Baroreflex; baroreflex sensitivity; Biomarkers - blood; brain natriuretic peptide; Causality; Electrocardiography, Ambulatory - methods; Female; Follow-Up Studies; heart failure; Heart Failure - blood; Heart Failure - epidemiology; Heart Rate; heart rate turbulence; heart rate variability; Hospitalization - statistics & numerical data; Humans; Kaplan-Meier Estimate; Male; Middle Aged; myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - epidemiology; Natriuretic Peptide, Brain - blood; Original; Predictive Value of Tests; Reproducibility of Results; Risk Factors; ROC Curve
• ISSN: 1082-720X; 1542-474X
• DOI: 10.1111/j.1542-474X.2010.00372.x

Background: Data on the value of baseline brain natriuretic peptide (BNP) and autonomic markers in predicting heart failure (HF) hospitalization after an acute myocardial infarction (AMI) are limited. Methods: A consecutive series of patients with AMI without a previous history of HF (n = 569) were followed up for 8 years. At baseline, the patients had a blood sample for determination of BNP, a 24‐hour Holter recording for evaluating heart rate variability (HRV) and heart rate turbulence (HRT), and an assessment of baroreflex sensitivity (BRS) using phenylephrine test. Results: During the follow‐up, 79 (14%) patients were hospitalized due to HF. Increased baseline BNP, decreased HRV, HRT, and BRS had a significant association with HF hospitalization in univariate comparisons (P < 0.001 for all). After adjusting with all the relevant clinical parameters, BNP, HRV, and HRT still significantly predicted HF hospitalization (P < 0.001 for BNP and for the short‐term scaling exponent α1, P < 0.01 for turbulence slope). In the receiver operator characteristics curve analysis, the area under the curve for BNP was 0.77, for the short‐term scaling exponent α1 0.69, for turbulence slope 0.71, and for BNP/standard deviation of all N‐N intervals ratio 0.80. Conclusion: Baseline increased BNP and impaired autonomic function after AMI yield significant information on the long‐term risk for HF hospitalization. Ann Noninvasive Electrocardiol 2010;15(3):250–258