Document Detail


Multi-scale heart rate dynamics detected by phase-rectified signal averaging predicts mortality after acute myocardial infarction.
MedLine Citation:
PMID:  23248218     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Acceleration and deceleration capacity (AC and DC) for beat-to-beat short-term heart rate dynamics are powerful predictors of mortality after acute myocardial infarction (AMI). We examined if AC and DC for minute-order long-term heart rate dynamics also have independent predictive value.
METHODS AND RESULTS: We studied 24-hr Holter electrcardiograms in 708 post-AMI patients who were followed up for up to 30 months thereafter. Acceleration capacity and DC was calculated with the time scales of T (window size defining heart rate) and s (wavelet scale) from 1 to 500 s and compared their prognostic values with conventional measures (AC(conv) and DC(conv)) that were calculated with (T,s) = [1,2 (beat)]. During the follow-up, 47 patients died. Both increased AC(conv) and decreased DC(conv) predicted mortality (C statistic, 0.792 and 0.797). Concordantly, sharp peaks of C statistics were observed at (T,s) = [2,7 (sec)] for both increased AC and decreased DC (0.762 and 0.768), but there were larger peaks of C statistics at around [30,60 (sec)] for both (0.783 and 0.796). The C statistic was greater for DC than AC at (30,60) (P = 0.0012). Deceleration capacity at (30,60) was a significant predictor even after adjusted for AC(conv) (P = 0.020) and DC(conv) (P = 0.028), but the predictive power of AC at (30,60) was no longer significant.
CONCLUSION: A decrease in DC for minute-order long-term heart rate dynamics is a strong predictor for post-AMI mortality and the predictive power is independent of AC(conv) and DC(conv) for beat-to-beat short-term heart rate dynamics.
Authors:
Masaya Kisohara; Phyllis K Stein; Yutaka Yoshida; Mari Suzuki; Narushi Iizuka; Robert M Carney; Lana L Watkins; Kenneth E Freedland; James A Blumenthal; Junichiro Hayano
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-12-17
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  15     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-22     Completed Date:  2013-08-12     Revised Date:  2014-03-07    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  437-43     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Chi-Square Distribution
Electrocardiography, Ambulatory*
Female
Heart Rate*
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction / diagnosis*,  mortality*,  physiopathology
Odds Ratio
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors
Signal Processing, Computer-Assisted*
Time Factors
Grant Support
ID/Acronym/Agency:
2 R01 HL058946/HL/NHLBI NIH HHS
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