Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction:: cohort study

被引:499
作者
Bauer, Axel
Kantelhardt, Jan W.
Barthel, Petra
Schneider, Raphael
Makikallio, Timo
Ulm, Kurt
Hnatkova, Katerina
Schornig, Albert
Huikuri, Heikki
Bunde, Armin
Malik, Marek
Schmidt, Georg [1 ]
机构
[1] Tech Univ Munich, Klinikum Rechts Isar, Erste Med Klin, D-8000 Munich, Germany
[2] Tech Univ Munich, Klinikum Rechts Isar, Deutsch Herzzentrum Munchen, D-8000 Munich, Germany
[3] Tech Univ Munich, Klinikum Rechts Isar, Inst Stat & Epidemiol, D-8000 Munich, Germany
[4] Univ Giessen, Inst Theoret Phys 3, D-35390 Giessen, Germany
[5] Univ Halle Wittenberg, Fachbereich Phys, D-4010 Halle, Germany
[6] Univ Oulu, Dept Med, Oulu, Finland
[7] Univ London, London WC1E 7HU, England
关键词
D O I
10.1016/S0140-6736(06)68735-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Decreased vagal activity after myocardial infarction results in reduced heart-rate variability and increased risk of death. To distinguish between vagal and sympathetic factors that affect heart-rate variability, we used a signal-processing algorithm to separately characterise deceleration and acceleration of heart rate. We postulated that diminished deceleration-related modulation of heart rate is an important prognostic marker. Our prospective hypotheses were that deceleration capacity is a better predictor of risk than left-ventricular ejection fraction (LVEF) and standard deviation of normal-to-normal intervals (SDNN). Methods We quantified heart rate deceleration capacity by assessing 24-h Holter recordings from a post-infarction cohort in Munich (n=1455). We blindly validated the prognostic power of deceleration capacity in post-infarction populations in London, UK (n=656), and Oulu, Finland (n=600). We tested our hypotheses by assessment of the area under the receiver-operator characteristics curve (AUC). Findings During a median follow-up of 24 months, 70 people died in the Munich cohort and 66 in the London cohort. The Oulu cohort was followed-up for 38 months and 77 people died. In the London cohort, mean AUC of deceleration capacity was 0.80 (SD 0.03) compared with 0.67 (0.04) for LVEF and 0.69 (0.04) for SDNN. In the Oulu cohort, mean AUC of deceleration capacity was 0.74 (0.03) compared with 0.60 (0.04) for LVEF and 0.64 (0.03) for SDNN (p<0.0001 for all comparisons). Stratification by dichotomised deceleration capacity was especially powerful in patients with preserved LVEF (p<0.0001 in all cohorts). Interpretation Impaired heart rate deceleration capacity is a powerful predictor of mortality after myocardial infarction and is more accurate than LVEF and the conventional measures of heart-rate variability.
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页码:1674 / 1681
页数:8
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