Document Detail

Usefulness of abnormal heart rate turbulence to predict cardiovascular mortality in high-risk patients with acute myocardial infarction and left ventricular dysfunction (from the EPHESUS study).
MedLine Citation:
PMID:  19463505     Owner:  NLM     Status:  MEDLINE    
Heart rate turbulence (HRT) is a promising marker for risk of mortality after acute myocardial infarction (AMI). We investigated HRT for risk stratification in high-risk patients after MI. HRT from 24-hour Holter monitoring in 481 hospitalized patients after AMI with heart failure and/or diabetes with left ventricular dysfunction before randomization in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS). Over a 1-year follow-up, 55 died, 49 of cardiovascular causes. HRT onset (TO) and slope (TS) were calculated using previous and cohort-optimized cutpoints and their independent contribution to risk of cardiovascular death determined. Models were tested with <5 ventricular premature complexes (PVCs) categorized as normal (n = 452) and with <5 VPCs excluded (n = 342). In EPHESUS, optimal cutpoints were TS < or = 3.0 and TO > or = 0.0. The strongest model for predicting cardiovascular mortality used EPHESUS cutpoints excluding subjects with <5 VPCs. On 3-category HRT model multivariate analysis (TS and TO normal, TS or TO abnormal, TS and TO abnormal), both TS and TO abnormal (relative risk 3.64, 95% confidence interval 1.55 to 8.55, p = 0.003) and left ventricular ejection fraction < or =30% (relative risk 1.97, 95% confidence interval 1.04 to 3.73, p = 0.037) independently predicted cardiovascular death. In conclusion, HRT is an independent predictor of cardiovascular death in a high-risk population after AMI, with a possibly higher optimal cutpoint for HRT slope than previously reported.
Phyllis K Stein; Prakash Deedwania
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-04-08
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-25     Completed Date:  2009-06-18     Revised Date:  2013-11-25    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1495-9     Citation Subset:  AIM; IM    
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MeSH Terms
Electrocardiography, Ambulatory
Heart Failure / drug therapy
Heart Rate / physiology*
Middle Aged
Mineralocorticoid Receptor Antagonists / therapeutic use
Myocardial Infarction / physiopathology
Risk Assessment
Spironolactone / analogs & derivatives,  therapeutic use
Ventricular Dysfunction, Left / mortality*,  physiopathology*
Reg. No./Substance:
0/Mineralocorticoid Receptor Antagonists; 27O7W4T232/Spironolactone; 6995V82D0B/eplerenone

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

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