Respiratory sinus arrhythmia as a predictor of sudden cardiac death after myocardial infarction

被引:16
作者
Peltola, Mirja [1 ]
Tulppo, Mikko P. [5 ]
Kiviniemi, Antti [5 ]
Hautala, Arto J. [5 ]
Seppanen, Tapio [2 ]
Barthel, Petra [3 ,4 ]
Bauer, Axel [3 ,4 ]
Schmidt, Georg [3 ,4 ]
Huikuri, Heikki V. [1 ]
Makikallio, Timo H. [1 ,6 ]
机构
[1] Univ Oulu, Dept Internal Med, Div Cardiol, FIN-90014 Oulu, Finland
[2] Univ Oulu, Dept Elect Engn, FIN-90014 Oulu, Finland
[3] Tech Univ Munich, Med Klin 1, Munich, Germany
[4] Tech Univ Munich, Deutsch Herzzentrum, Munich, Germany
[5] Verve Res, Oulu, Finland
[6] Lapland Cent Hosp, Rovaniemi, Finland
关键词
heart rate; respiratory sinus arrhythmia; sudden cardiac death;
D O I
10.1080/07853890701884659
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Measurement of high-frequency (HF) spectral power of heart rate (HR) variability has not been able to identify the patients at risk of sudden cardiac death (SCD) despite the experimental evidence of protective role of vagal activity for fatal arrhythmias. Aim. We developed a novel respiratory sinus arrhythmia (RSA) analysis method and tested its ability to predict SCD after an acute myocardial infarction. Method. The RSA analysis method was developed in 13 subjects from simultaneous recordings of respiration and R-R intervals. An adaptive threshold was computed based on the zero-phase forward and reverse digital filtering in the analysis of RSA. With this method, only respiration-related R-R interval fluctuations are included. The prognostic power of RSA, analyzed from 24-hour electrocardiographic recordings, was subsequently assessed in a large postinfarction population including 1631 patients with mean follow-up of 4017 months. Results. Depressed RSA was a strong predictor of SCD (hazard ratio 7.4; 95% CI 3.6-15.1; P <0.0001) but only a weak predictor of non-SCD. The RSA index remained an independent predictor of SCD after adjustments for ejection fraction and other clinical risk variables (RR 4.7; 95% CI 2.28-9.85). Conclusions. Reduced respiratory-related HR dynamics, detected by RSA index, are a specific marker of an increased risk of SCD among postinfarction patients.
引用
收藏
页码:376 / 382
页数:7
相关论文
共 27 条
[21]   AUTONOMIC MECHANISMS AND SUDDEN-DEATH - NEW INSIGHTS FROM ANALYSIS OF BARORECEPTOR REFLEXES IN CONSCIOUS DOGS WITH AND WITHOUT A MYOCARDIAL-INFARCTION [J].
SCHWARTZ, PJ ;
VANOLI, E ;
STRAMBABADIALE, M ;
DEFERRARI, GM ;
BILLMAN, GE ;
FOREMAN, RD .
CIRCULATION, 1988, 78 (04) :969-979
[22]   Sometimes higher heart rate variability is not better heart rate variability: Results of graphical and nonlinear analyses [J].
Stein, PK ;
Domitrovich, PP ;
Hui, N ;
Rautaharju, P ;
Gottdiener, J .
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 2005, 16 (09) :954-959
[23]  
*TAST FORC EUR SOC, 1996, EUR HEART, V17, P354
[24]   Physiological background of the loss of fractal heart rate dynamics [J].
Tulppo, MP ;
Kiviniemi, AM ;
Hautala, AJ ;
Kallio, M ;
Seppänen, T ;
Mäkikallio, TH ;
Huikuri, HV .
CIRCULATION, 2005, 112 (03) :314-319
[25]   Vagal modulation of heart rate during exercise:: effects of age and physical fitness [J].
Tulppo, MP ;
Mäkikallio, TH ;
Seppanen, T ;
Laukkanen, RT ;
Huikuri, HV .
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 1998, 274 (02) :H424-H429
[26]   PATTERNS OF BEAT-TO-BEAT HEART-RATE-VARIABILITY IN ADVANCED HEART-FAILURE [J].
WOO, MA ;
STEVENSON, WG ;
MOSER, DK ;
TRELEASE, RB ;
HARPER, RM .
AMERICAN HEART JOURNAL, 1992, 123 (03) :704-710
[27]   Respiratory sinus arrhythmia - Why does the heartbeat synchronize with respiratory rhythm? [J].
Yasuma, F ;
Hayano, J .
CHEST, 2004, 125 (02) :683-690