Document Detail


Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study.
MedLine Citation:
PMID:  16714188     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Axel Bauer; Jan W Kantelhardt; Petra Barthel; Raphael Schneider; Timo Mäkikallio; Kurt Ulm; Katerina Hnatkova; Albert Schömig; Heikki Huikuri; Armin Bunde; Marek Malik; Georg Schmidt
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  367     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-22     Completed Date:  2006-06-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1674-81     Citation Subset:  AIM; IM    
Affiliation:
Deutsches Herzzentrum München, Klinikum rechts der Isar, Technische Universität München, Germany.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiotonic Agents / therapeutic use
Cohort Studies
Deceleration
Electrocardiography, Ambulatory / methods*
Female
Heart Rate*
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy,  mortality*
Predictive Value of Tests
ROC Curve
Risk Factors
Stroke Volume
Chemical
Reg. No./Substance:
0/Cardiotonic Agents
Comments/Corrections
Comment In:
Lancet. 2006 May 20;367(9523):1639-41   [PMID:  16714171 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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