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Connell PS, Price JF, Rusin CG, Howard TS, Spinner JA, Valdes SO, Pham TDN, Miyake CY, Kim JJ. Decreased Heart Rate Variability in Children with Acute Decompensated Heart Failure is Associated with Poor Outcomes. Pediatr Cardiol 2023:10.1007/s00246-023-03279-7. [PMID: 37698699 DOI: 10.1007/s00246-023-03279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
Heart rate variability (HRV) is a noninvasive indicator of the health of neurocardiac interactions of the autonomic nervous system. In adults, decreased HRV correlates with increased cardiovascular mortality. However, the relationship between HRV and outcomes in children with acute decompensated heart failure (ADHF) has not been described. Patients < 21 years old hospitalized with ADHF from 2013 to 2019 were included (N = 79). Primary outcome was defined as death, heart transplant, or mechanical circulatory support (MCS). The median standard deviation of the R-to-R interval in 5-min intervals (SDNN) was calculated from telemetry data obtained across the first 24 h of admission. Patients who met the primary outcome had significantly lower median SDNN (13.8 [7.8, 29.1]) compared to those who did not (24.6 [15.3, 84.4]; p = 0.004). A median SDNN of 20 ms resulted in a sensitivity of 68% and specificity of 69%. Median SDNN < 20 ms represented decreased freedom from primary outcome (p = 0.043) and a hazard ratio of 2.2 in multivariate analysis (p = 0.016). Pediatric patients with ADHF who died, underwent heart transplant, or required MCS had significantly decreased HRV at presentation compared to those that did not. This supports HRV as a noninvasive tool to improve prognostication in children in ADHF.
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Affiliation(s)
- Patrick S Connell
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA.
| | - Jack F Price
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA
| | - Craig G Rusin
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA
| | - Taylor S Howard
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA
| | - Joseph A Spinner
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA
| | - Santiago O Valdes
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA
| | - Tam Dan N Pham
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA
| | - Christina Y Miyake
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey J Kim
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St., MS BCM320, Houston, TX, 77030, USA
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de Lepper AGW, Buck CMA, van 't Veer M, Huberts W, van de Vosse FN, Dekker LRC. From evidence-based medicine to digital twin technology for predicting ventricular tachycardia in ischaemic cardiomyopathy. JOURNAL OF THE ROYAL SOCIETY, INTERFACE 2022; 19:20220317. [PMID: 36128708 DOI: 10.1098/rsif.2022.0317] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Survivors of myocardial infarction are at risk of life-threatening ventricular tachycardias (VTs) later in their lives. Current guidelines for implantable cardioverter defibrillators (ICDs) implantation to prevent VT-related sudden cardiac death is solely based on symptoms and left ventricular ejection fraction. Catheter ablation of scar-related VTs is performed following ICD therapy, reducing VTs, painful shocks, anxiety, depression and worsening heart failure. We postulate that better prediction of the occurrence and circuit of VT, will improve identification of patients at risk for VT and boost preventive ablation, reducing mortality and morbidity. For this purpose, multiple time-evolving aspects of the underlying pathophysiology, including the anatomical substrate, triggers and modulators, should be part of VT prediction models. We envision digital twins as a solution combining clinical expertise with three prediction approaches: evidence-based medicine (clinical practice), data-driven models (data science) and mechanistic models (biomedical engineering). This paper aims to create a mutual understanding between experts in the different fields by providing a comprehensive description of the clinical problem and the three approaches in an understandable manner, leveraging future collaborations and technological innovations for clinical decision support. Moreover, it defines open challenges and gains for digital twin solutions and discusses the potential of hybrid modelling.
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Affiliation(s)
| | - Carlijn M A Buck
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Lukas R C Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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He M, Zhao WB, Nguyen MN, Kiriazis H, Li YQ, Hu H, Du XJ. Association between heart rate variability indices and features of spontaneous ventricular tachyarrhythmias in mice. Clin Exp Pharmacol Physiol 2020; 47:1193-1202. [PMID: 32027390 DOI: 10.1111/1440-1681.13275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/20/2022]
Abstract
Direct evidence is limited for the association between heart rate variability (HRV) indices and ventricular tachyarrhythmias (VTAs). While galectin-3 (Gal-3) is regarded as a causal factor for cardiac remodelling and a biomarker for arrhythmias, its regulation on VTAs and HVR is unknown. Using aged transgenic (TG) mice with cardiac overexpression of β2 -adrenoceptors and spontaneous VTAs, we studied whether changes in HRV indices correlated with the severity of VTAs, and whether Gal-3 gene knockout (KO) in TG mice might limit VTA. Body-surface ECG was recorded (10-minute period) in 9- to 10-month-old mice of non-transgenic (nTG), TG and TG × Gal-3 knockout (TG/KO). Time-domain, frequency-domain and nonlinear-domain HRV indices were calculated using the R-R intervals extracted from ECG signals and compared with frequency of VTAs. TG and TG/KO mice developed frequent VTAs and showed significant changes in certain time-domain and nonlinear-domain HRV indices relative to nTG mice. The severity of VTAs in TG and TG/KO mice in combination, estimated by VTA counts and arrhythmia score, was significantly correlated with certain time-domain and nonlinear-domain HRV indices. In conclusion, significant changes in HRV indices were evident and correlated with the severity of spontaneous VTAs in TG mice. The frequency of VTA and HRV indices were largely comparable between TG and TG/KO mice. Deletion of Gal-3 in TG mice altered certain HRV indices implying influence by neuronally localized Gal-3 on autonomic nervous activity.
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Affiliation(s)
- Mi He
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,School of Biomedical Engineering and Imaging Medicine, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei-Bo Zhao
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - My-Nhan Nguyen
- Experimental Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Helen Kiriazis
- Experimental Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Yong-Qin Li
- School of Biomedical Engineering and Imaging Medicine, Third Military Medical University (Army Medical University), Chongqing, China
| | - Houyuan Hu
- Department of Cardiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiao-Jun Du
- Experimental Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.,Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi'an Jiaotong University (Health Science Center), Xi'an, China
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Boonhoh W, Kijtawornrat A, Sawangkoon S. Comparative effects of amiodarone and dronedarone treatments on cardiac function in a rabbit model. Vet World 2019; 12:345-351. [PMID: 31040580 PMCID: PMC6460874 DOI: 10.14202/vetworld.2019.345-351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/16/2019] [Indexed: 11/23/2022] Open
Abstract
Aim: The objective of the study was to compare the effects of amiodarone (AM) and dronedarone (DR) on heart rate variability (HRV) and cardiac contractility in a rabbit model. Materials and Methods: A total of 16 male New Zealand white rabbits were divided into two groups, treated either with AM or DR at incremental dosages of 50 mg/kg/day (AM50 and DR50) and 100 mg/kg/day (AM100 and DR100), orally administrated for 7 days. At the end of each period, electrocardiograms were recorded during consciousness and analyzed using the short-term time and frequency domains of HRV. Standard echocardiography and speckle-tracking echocardiography were studied during immobilization with xylazine and ketamine. Results: The results showed that AM100 and DR100 significantly decreased heart rate, total power, low-frequency component, and low-to-high frequency ratio compared with baselines. Most echocardiogram parameters revealed no significant difference from baselines, except for the global circumferential plane strain rate and time to peak standard deviation of strain, which had statistical significances after treating with AM. Conclusion: Both AM and DR possess negative chronotropy and reduce HRV, which may be explained by their sympathetic suppression and calcium channel blocking activities. Theoretically, both antiarrhythmic drugs may also possess negative inotropy, but only AM is shown to have a negative inotropic effect and reduces cardiac dyssynchrony in this model.
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Affiliation(s)
- Worakan Boonhoh
- Department of Physiology, Animal Physiology Program, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Anusak Kijtawornrat
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand.,Research Clusters: Research Study and Testing of Drug's Effect Related to Cardiovascular System in Laboratory Animal, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
| | - Suwanakiet Sawangkoon
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, 39 Henri Dunant Road, Pathumwan, Bangkok 10330, Thailand
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Blackman AO, Sobral Neto J, Lima ML, Rodrigues TMA, Gomes OM. Assessment and clinical relevance of the dynamic parameters of ventricular repolarization in patients with grade I left ventricular diastolic dysfunction 1. Can J Physiol Pharmacol 2019; 97:577-580. [PMID: 30676775 DOI: 10.1139/cjpp-2018-0507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Imbalance in ventricular repolarization parameters are related to increased risk of severe arrhythmia and sudden cardiac death. There is limited research regarding markers to detect patients at risk in this early stage. We aimed to assess the influence of grade I left ventricular diastolic dysfunction on repolarization parameters in asymptomatic patients. Ambulatory patients with grade I left ventricular diastolic dysfunction were studied and compared with a control group. We assessed the QT dispersion circadian variation, heart rate variability in the time and frequency domains, and dynamics of QT using a 12-lead Holter. In the diastolic dysfunction group, 8 (30%) patients had QT dispersion > 80 ms. One (3.8%) patient presented premature ventricular complex > 10/h. The comparison between the 2 groups showed that the difference between the standard deviation of normal-to-normal intervals and low frequency power in both groups was statistically significant. We therefore conclude that increased parameters of ventricular repolarization and depressed heart rate variability reflect an imbalance in autonomic responses in patients with grade I left ventricular diastolic dysfunction without cardiovascular symptoms, enabling the identification of patients that are at a higher risk for cardiovascular events.
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Affiliation(s)
- Antoinette Oliveira Blackman
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil.,b Centro de Avaliação Cardiológica de Brasília - Centrocard, Brasília, DF, Brazil.,c Faculdade de Medicina, Uniceub, Brasília, DF, Brazil
| | - José Sobral Neto
- b Centro de Avaliação Cardiológica de Brasília - Centrocard, Brasília, DF, Brazil
| | - Melchior Luiz Lima
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil
| | | | - Otoni Moreira Gomes
- a Instituto Cardiovascular São Francisco de Assis - Hospital Servcor, Belo Horizonte, MG, Brazil
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Fortes Silva HE, de Almeida RS, Silveira DB, Llaguno M, Resende LAPR, Dias da Silva VJ, Correia D. Cardiac autonomic modulation and long-term use of amiodarone in patients with chronic Chagasic cardiopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:788-798. [PMID: 29781516 DOI: 10.1111/pace.13384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/24/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with chronic Chagas cardiopathy (CCC), which may be associated with cardiac arrhythmias, frequently use amiodarone, an antiarrhythmic drug that, experimentally, appears to modulate the cardiac autonomic function. OBJECTIVE The present cross-sectional observational study aimed to evaluate autonomic cardiac modulation in patients with CCC undergoing chronic amiodarone therapy. METHODS Three groups were investigated: Group 1 included patients with CCC not treated with amiodarone (n = 27); Group 2 included patients with CCC with prolonged use (at least 6 months) of amiodarone (n = 16); and Group 3 included non-Chagasic control patients (n = 23). All patients underwent a complete clinical and laboratory assessment, followed by autonomic function tests, consisting of a basal continuous electrocardiogram in the resting supine position for 10 minutes, followed by a change the orthostatic posture for a further 5 minutes. Heart rate variability (HRV) parameters (median and interquartile interval) were quantified using linear methods in the time- and frequency-domains (autoregressive spectral analysis) and nonlinear methods, including symbolic analysis. RESULTS Patients with CCC using amiodarone had changes in HRV suggestive of an offset in the sympatho-vagal balance with a vagal modulation predominance (normalized HF, 49.7[27.4] vs 31.1[22.8] [P < 0.05]; and percentage 2V, 40.1 [14.6] vs 21.5 [13.4] [P < 0.05] vs untreated CCC group). These changes were further accompanied by increases in parameters indicative of greater complexity of HRV. CONCLUSIONS The deviation in the sympatho-vagal balance and the increase in the complexity of HRV strongly suggest that amiodarone may have a cardioprotective effect, in addition to its antiarrhythmic effects, which could increase the survival of these patients.
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Affiliation(s)
- Henriette Elena Fortes Silva
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Renan Sandoval de Almeida
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Danilo Batista Silveira
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Maurício Llaguno
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | | | - Valdo José Dias da Silva
- Department of Physiology, Natural and Biological Sciences Institute, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
| | - Dalmo Correia
- Division of Infectious Diseases, Internal Medicine Department, Triangulo Mineiro Federal University, Uberaba, MG, Brazil
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Daniłowicz-Szymanowicz L, Kaufmann D, Rozwadowska K, Kempa M, Lewicka E, Raczak G. Microvolt T-wave alternans and autonomic nervous system parameters can be helpful in the identification of low-arrhythmic risk patients with ischemic left ventricular systolic dysfunction. PLoS One 2018; 13:e0196812. [PMID: 29723261 PMCID: PMC5933691 DOI: 10.1371/journal.pone.0196812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/22/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The role of implantable cardioverter-defibrillator (ICD) placement in the primary prevention of sudden cardiac death (SCD) in all consecutive patients with left ventricular ejection fraction (LVEF) ≤ 35% is still a matter of hot debate due to the fact that the population of these patients is highly heterogeneous in terms of the SCD risk. Nevertheless, reduced LVEF is still the only established criterion during qualification of patients for ICD implantation in the primary prevention of SCD, therefore identification of persons with particularly high risk among patients with LVEF ≤35% is currently of lesser importance. More important seems to be the selection of individuals with relatively low risk of SCD in whom ICD implantation can be safely postponed. The aim of the study was to determine whether well-known, non-invasive parameters, such as microvolt T-wave alternans (MTWA), baroreflex sensitivity (BRS) and short-term heart rate variability (HRV), can be helpful in the identification of low-arrhythmic risk patients with ischemic left ventricular systolic dysfunction. METHODS In 141 patients with coronary artery disease and LVEF ≤ 35%, MTWA testing, as well as BRS and short-term HRV parameters, were analysed. During 34 ± 13 months of follow-up 37 patients had arrhythmic episode (EVENT): SCD, non-fatal sustained ventricular arrhythmia (ventricular tachycardia [VT] or ventricular fibrillation [VF]), or adequate high-voltage ICD intervention (shock) due to a rapid ventricular arrhythmia ≥200/min. LVEF, non-negative MTWA (MTWA_non-neg), BRS and low frequency power in normalized units (LFnu) turned out to be associated with the incidence of EVENT in univariate Cox analysis. The cut-off values for BRS and LFnu that most accurately distinguished between patients with and without EVENT were 3 ms/mmHg and 23, respectively. The only variable that provided 100% negative predictive value (NPV) for EVENT was negative MTWA result (MTWA_neg), but solely for initial 12 months of the follow-up; the NPVs for other potential predictors of the EVENT were lower. The cut-off values for BRS and LFnu that provide 100% NPV for EVENT during 12 and 24 months were higher: 6.0 ms/mmHg and 73 respectively, but the gain in the NPV occurred at an expense of the number of identified patients. However, the number of identified non-risk patients turned out to be higher when the predictive model included MTWA_neg and the lower cut-off values for ANS parameters: 100% NPV for 12 and 24 months of follow-up was obtained for combination MTWA_neg and BRS ≥ 3 ms/mmHg, for combination MTWA_neg and LFnu ≥ 23 100% NPV was obtained for 12 months. CONCLUSION Well-known, non-invasive parameters, such as MTWA, BRS and short-term HRV indices may be helpful in the identification of individuals with a relatively low risk of malignant ventricular arrhythmias among patients with ischemic left ventricular systolic dysfunction; in such persons, implantation of ICD could be safely postponed.
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Affiliation(s)
| | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Rozwadowska
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
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Takenouchi A, Tsuboi A, Kitaoka K, Minato S, Kurata M, Fukuo K, Kazumi T. Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability Is an Independent Determinant of Carotid Intima-Media Thickness in Patients With Type 2 Diabetes. J Clin Med Res 2017; 9:310-316. [PMID: 28270891 PMCID: PMC5330774 DOI: 10.14740/jocmr2871w] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 01/31/2023] Open
Abstract
Background Studies demonstrated that visit-to-visit variability in low-density lipoprotein cholesterol (LDLC) is an independent predictor of cardiovascular events in subjects with coronary artery disease. Whether visit-to-visit variability in LDLC levels affects subclinical atherosclerosis is unknown. This study sought to evaluate the role of visit-to-visit variability in LDLC levels on subclinical atherosclerosis. Methods We evaluated 162 type 2 diabetic patients with measurement of carotid intima-media thickness (IMT). Intrapersonal mean and standard deviation (SD) of six measurements of LDLC during 12 months were calculated. Multivariate linear regressions assessed the independent correlates of carotid IMT. Results The mean and SD of LDLC were 112 ± 22 and 15 ± 10 mg/dL, respectively, and 43.2% of patients were on hypolipidemic drugs. Age (standardized β = 0.355, P < 0.001), male sex (standardized β = 0.234, P = 0.002) and SD-LDLC (standardized β = 0.201, P = 0.009) emerged as independent determinants of carotid maximum IMT independently of mean LDLC levels, body mass index (BMI), waist circumference, duration and treatment of diabetes, means and SDs of glycemic and other lipid variables, and uses of hypolipidemic and anti-hypertensive medications (R2 = 0.15). Results did not change when mean IMT was used instead of maximum IMT. After controlling for age and sex, maximum IMT was thicker in patients with the highest compared to those with other three quartiles of SD-LDLC combined (1.14 ± 0.04 (SE) vs. 1.01 ± 0.02 mm, P = 0.01). Independent determinants of SD-LDLC were mean LDLC, use of hypolipidemic drugs, fasting triglyceride and visit-to-visit variability in HbA1c. Conclusions Consistency of LDLC levels may be important to subclinical atherosclerosis in real-world patients with type 2 diabetes. It may be important for patients on lipid-lowering drugs to prevent non-compliance.
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Affiliation(s)
- Akiko Takenouchi
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan
| | - Ayaka Tsuboi
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan; Department of Nutrition, Osaka City Juso Hospital, Osaka, Japan
| | - Kaori Kitaoka
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan; Department of Nutritional Sciences for Well-Being, Faculty of Health Sciences for Welfare, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Satomi Minato
- Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan; Graduate School of Human Science and Environment, University of Hyogo, Himeji, Hyogo, Japan
| | - Miki Kurata
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan; Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
| | - Keisuke Fukuo
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan; Research Institute for Nutrition Sciences, Mukogawa Women's University, Nishinomiya, Hyogo, Japan
| | - Tsutomu Kazumi
- Department of Food Sciences and Nutrition, School of Human Environmental Sciences, Nishinomiya, Hyogo, Japan; Division of Diabetes, Department of Medicine, Konan Kakogawa Hospital, Kakogawa, Hyogo, Japan
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Bauer A, Camm AJ, Cerutti S, Guzik P, Huikuri H, Lombardi F, Malik M, Peng CK, Porta A, Sassi R, Schmidt G, Schwartz PJ, Stein PK, Yamamoto Y. Reference values of heart rate variability. Heart Rhythm 2017; 14:302-303. [DOI: 10.1016/j.hrthm.2016.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Obstructive sleep apnea is associated with visit-to-visit variability in low-density lipoprotein-cholesterol in patients with coronary artery disease. Sleep Breath 2016; 21:271-278. [DOI: 10.1007/s11325-016-1394-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/18/2016] [Accepted: 07/27/2016] [Indexed: 01/14/2023]
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Boey E, Gay GMW, Poh KK, Yeo TC, Tan HC, Lee CH. Visit-to-visit variability in LDL- and HDL-cholesterol is associated with adverse events after ST-segment elevation myocardial infarction: A 5-year follow-up study. Atherosclerosis 2015; 244:86-92. [PMID: 26595903 DOI: 10.1016/j.atherosclerosis.2015.10.110] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/06/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We evaluated the relationship between visit-to-visit low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) variability and 5-year clinical outcomes in patients who presented with ST-segment elevation myocardial infarction (STEMI). METHODS 130 patients presenting with STEMI and surviving to discharge were analyzed. Visit-to-visit LDL-C and HDL-C variability was evaluated from 2 months after discharge on the basis of corrected variation independent of mean (cVIM, primary measure), coefficient of variation and standard deviation. Major adverse cardiac event (MACE) included death, myocardial infarction, stroke, unplanned revascularization, and heart failure admission. RESULTS After an average of 62.4 ± 30.5 months follow-up, 41 patients (31.5%) had experienced MACE. Compared with the non-MACE group, the MACE group had a higher visit-to-visit LDL-C variability (cVIM: 0.23 ± 0.11 vs. 0.19 ± 0.08; p = 0.049; coefficient of variation: 0.24 ± 0.12 vs. 0.19 ± 0.00; p = 0.019; standard deviation: 24.1 ± 14.5 vs. 17.6 ± 10.0; p = 0.006), mean follow-up LDL-C (p = 0.033) and a higher prevalence of diabetes mellitus (p = 0.012). After adjusting for mean follow-up cholesterol levels and diabetes mellitus, each 0.01 cVIM increase in LDL-C and HDL-C variability increased the risk of MACE by 3.4% (HR: 1.034; 95% CI: 1.004 to 1.065; p = 0.025) and 6.8% (HR: 1.068; 95% CI: 1.003 to 1.137; p = 0.04), respectively. Results derived from coefficient of variation and standard deviation as measures of cholesterol variability were similar. CONCLUSION This is the first report to show an independent association between visit-to-visit LDL-C and HDL-C variability and long-term MACE in patients presenting with STEMI.
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Affiliation(s)
- Elaine Boey
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Gibson Ming Wei Gay
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Cygankiewicz I, Corino V, Vazquez R, Bayes-Genis A, Mainardi L, Zareba W, de Luna AB, Platonov PG. Reduced Irregularity of Ventricular Response During Atrial Fibrillation and Long-term Outcome in Patients With Heart Failure. Am J Cardiol 2015; 116:1071-5. [PMID: 26298305 DOI: 10.1016/j.amjcard.2015.06.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 11/16/2022]
Abstract
Reduced heart rate variability (HRV) is associated with poor outcome in patients with heart failure (HF). However, the data on predictive value of RR variability during atrial fibrillation (AF) are limited. Therefore, the aim of this study was to evaluate the association between ventricular response characteristics and long-term clinical outcome in the population of ambulatory patients with mild-to-moderate HF and AF at baseline. The study included 155 patients (mean age 69 ± 10 years) with AF at 20-minute Holter electrocardiographic (ECG) recordings at enrollment. HRV analysis included SDNN, rMSSD, and pNN50, whereas irregularity indexes included 2 nonlinear parameters: approximate entropy (ApEn) and Shannon entropy. After median 41 months of follow-up, 54 patients died, including 21 HF related and 16 sudden deaths. Patients with ApEn ≤1.68 (lower tertile) had 40% mortality versus 12% in others (p <0.001) at 2 years of follow-up. Only nonlinear HRV parameters (irregularity but not variability indexes) identified patients at higher risk during follow-up. Decreased ApEn ≤1.68 was an independent predictor of total mortality (hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.61 to 4.89, p <0.001), sudden cardiac death (HR 3.83, 95% CI 1.31 to 11.25, p = 0.014), and HF death (HR 3.45, 95% CI 1.42 to 8.38, p = 0.006) in a multivariate Cox analysis. In conclusion, in a post hoc analysis of Muerte Subita en Insufficiencia Cardiaca study AF cohort, reduced irregularity of RR intervals during AF, likely caused by autonomic dysfunction, was an independent predictor of all-cause mortality and sudden death and HF progression in patients with mild-to-moderate HF, whereas traditional HRV indexes did not predict outcome.
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Affiliation(s)
- Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.
| | - Valentina Corino
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Rafael Vazquez
- Cardiology Service, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | | | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Wojciech Zareba
- Heart Research Follow Up Program, University of Rochester Medical Center, Rochester, New York
| | - Antoni Bayes de Luna
- Catalan Institute of Cardiovascular Sciences, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden; Center for Integrative Electrocardiology at Lund University and Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
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13
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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14
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36:2793-2867. [PMID: 26320108 DOI: 10.1093/eurheartj/ehv316] [Citation(s) in RCA: 2512] [Impact Index Per Article: 279.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Acute Disease
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/therapy
- Autopsy/methods
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathies/complications
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Catheter Ablation/methods
- Child
- Coronary Artery Disease/complications
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/prevention & control
- Defibrillators
- Drug Therapy, Combination
- Early Diagnosis
- Emergency Treatment/methods
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Heart Transplantation/methods
- Heart Valve Diseases/complications
- Heart Valve Diseases/therapy
- Humans
- Mental Disorders/complications
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Myocarditis/complications
- Myocarditis/therapy
- Nervous System Diseases/complications
- Nervous System Diseases/therapy
- Out-of-Hospital Cardiac Arrest/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Primary Prevention/methods
- Quality of Life
- Risk Assessment
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Sports/physiology
- Stroke Volume/physiology
- Terminal Care/methods
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
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15
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Jørgensen RM, Abildstrøm SZ, Levitan J, Kobo R, Puzanov N, Lewkowicz M, Huikuri H, Peltola M, Haarbo J, Thomsen PEB. Heart Rate Variability Density Analysis (Dyx) and Prediction of Long-Term Mortality after Acute Myocardial Infarction. Ann Noninvasive Electrocardiol 2015; 21:60-8. [PMID: 26262922 DOI: 10.1111/anec.12297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
AIMS The density HRV parameter Dyx is a new heart rate variability (HRV) measure based on multipole analysis of the Poincaré plot obtained from RR interval time series, deriving information from both the time and frequency domain. Preliminary results have suggested that the parameter may provide new predictive information on mortality in survivors of acute myocardial infarction (MI). This study compares the prognostic significance of Dyx to that of traditional linear and nonlinear measures of HRV. METHODS AND RESULTS In the Nordic ICD pilot study, patients with an acute MI were screened with 2D echocardiography and 24-hour Holter recordings. The study was designed to assess the power of several HRV measures to predict mortality. Dyx was tested in a subset of 206 consecutive Danish patients with analysable Holter recordings. After a median follow-up of 8.5 years 70 patients had died. Of all traditional and multipole HRV parameters, reduced Dyx was the most powerful predictor of all-cause mortality (HR 2.4; CI 1.5 to 3.8; P < 0.001). After adjustment for known risk markers, such as age, diabetes, ejection fraction, previous MI and hypertension, Dyx remained an independent predictor of mortality (P = 0.02). Reduced Dyx also predicted cardiovascular death (P < 0.01) and sudden cardiovascular death (P = 0.05). In Kaplan-Meier analysis, Dyx significantly predicted mortality in patients both with and without impaired left ventricular systolic function (P < 0.0001). CONCLUSION The new nonlinear HRV measure Dyx is a promising independent predictor of mortality in a long-term follow-up study of patients surviving a MI, irrespectively of left ventricular systolic function.
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Affiliation(s)
| | | | - Jacob Levitan
- Department of Physics, Ariel University, Samaria, Israel
| | - Roi Kobo
- Department of Physics, Ariel University, Samaria, Israel
| | | | - Meir Lewkowicz
- Department of Physics, Ariel University, Samaria, Israel
| | - Heikki Huikuri
- Department of Internal Medicine, University of Oulu, Finland
| | - Mirja Peltola
- Department of Internal Medicine, University of Oulu, Finland
| | - Jens Haarbo
- Department of Cardiology, Copenhagen University Hospital Gentofte, Denmark
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16
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Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings. BIOMED RESEARCH INTERNATIONAL 2015; 2015:680515. [PMID: 26078960 PMCID: PMC4452832 DOI: 10.1155/2015/680515] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/14/2014] [Indexed: 11/23/2022]
Abstract
Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.
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17
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Almeida-Santos MA, Sousa ACS. Heart rate variability and Chagas heart disease. Arq Bras Cardiol 2015; 104:90-1. [PMID: 25714408 PMCID: PMC4387616 DOI: 10.5935/abc.20150003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/13/2014] [Accepted: 11/13/2014] [Indexed: 12/02/2022] Open
Affiliation(s)
- Marcos Antonio Almeida-Santos
- Faculdade de Medicina da Universidade Tiradentes, Aracaju, SE –
Brazil
- Centro de Ensino e Pesquisa da Fundação São Lucas, Aracaju, SE –
Brazil
| | - Antonio Carlos Sobral Sousa
- Centro de Ensino e Pesquisa da Fundação São Lucas, Aracaju, SE –
Brazil
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe
(UFS), Aracaju, SE – Brazil
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18
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Zaman S, Kovoor P. Sudden cardiac death early after myocardial infarction: pathogenesis, risk stratification, and primary prevention. Circulation 2014; 129:2426-35. [PMID: 24914016 DOI: 10.1161/circulationaha.113.007497] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sarah Zaman
- From the Westmead Hospital, Sydney, and University of Sydney, Sydney, Australia
| | - Pramesh Kovoor
- From the Westmead Hospital, Sydney, and University of Sydney, Sydney, Australia.
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19
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Hasan MA, Abbott D, Baumert M. Beat-to-beat QT interval variability and T-wave amplitude in patients with myocardial infarction. Physiol Meas 2013; 34:1075-83. [PMID: 23956333 DOI: 10.1088/0967-3334/34/9/1075] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to investigate the effects of T-wave amplitude and ECG lead on beat-to-beat QT interval variability (QTV) in patients with myocardial infarction (MI) compared to healthy subjects. Standard resting 12-lead ECGs of 79 MI patients and 69 healthy subjects were investigated. Beat-to-beat QT intervals were measured separately for each lead using a template matching algorithm. In addition, we extracted the beat-to-beat T-wave amplitude in each lead. We computed the standard deviation of beat-to-beat QT intervals as a marker of QTV for both healthy subjects and MI patients. Significant QTV differences were observed between the 12 ECG leads as well as between the groups of healthy subjects and MI patients. Beat-to-beat QTV was significantly higher in MI patients than in healthy subjects for half of the leads. Furthermore, significant T-wave amplitude differences across leads and between groups were observed. A significant inverse relation between beat-to-beat QTV and T-wave amplitude was demonstrated. The group differences in QTV remained significant after co-varying for the T-wave amplitude. In conclusion, the increase in beat-to-beat QTV that has been repeatedly reported in patients with MI is partly due to the lower T-wave amplitudes. However, QTV remains significantly increased in MI patients after covarying for this effect.
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Affiliation(s)
- M A Hasan
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, Australia
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20
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Lakusic N, Mahovic D, Sonicki Z, Slivnjak V, Baborski F. Outcome of patients with normal and decreased heart rate variability after coronary artery bypass grafting surgery. Int J Cardiol 2013; 166:516-8. [PMID: 22560918 DOI: 10.1016/j.ijcard.2012.04.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 03/10/2012] [Accepted: 04/08/2012] [Indexed: 11/25/2022]
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21
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Peltola MA. Role of editing of R-R intervals in the analysis of heart rate variability. Front Physiol 2012; 3:148. [PMID: 22654764 PMCID: PMC3358711 DOI: 10.3389/fphys.2012.00148] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 05/02/2012] [Indexed: 01/08/2023] Open
Abstract
This paper reviews the methods used for editing of the R–R interval time series and how this editing can influence the results of heart rate (HR) variability analyses. Measurement of HR variability from short and long-term electrocardiographic (ECG) recordings is a non-invasive method for evaluating cardiac autonomic regulation. HR variability provides information about the sympathetic-parasympathetic autonomic balance. One important clinical application is the measurement of HR variability in patients suffering from acute myocardial infarction. However, HR variability signals extracted from R–R interval time series from ambulatory ECG recordings often contain different amounts of artifact. These false beats can be either of physiological or technical origin. For instance, technical artifact may result from poorly fastened electrodes or be due to motion of the subject. Ectopic beats and atrial fibrillation are examples of physiological artifact. Since ectopic and other false beats are common in the R–R interval time series, they complicate the reliable analysis of HR variability sometimes making it impossible. In conjunction with the increased usage of HR variability analyses, several studies have confirmed the need for different approaches for handling false beats present in the R–R interval time series. The editing process for the R–R interval time series has become an integral part of these analyses. However, the published literature does not contain detailed reviews of editing methods and their impact on HR variability analyses. Several different editing and HR variability signal pre-processing methods have been introduced and tested for the artifact correction. There are several approaches available, i.e., use of methods involving deletion, interpolation or filtering systems. However, these editing methods can have different effects on HR variability measures. The effects of editing are dependent on the study setting, editing method, parameters used to assess HR variability, type of study population, and the length of R–R interval time series. The purpose of this paper is to summarize these pre-processing methods for HR variability signal, focusing especially on the editing of the R–R interval time series.
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Affiliation(s)
- Mirja A Peltola
- Department of Internal Medicine, Institute of Clinical Medicine, University of Oulu Oulu, Finland
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22
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Platonov PG, Holmqvist F. Atrial fibrillatory rate and irregularity of ventricular response as predictors of clinical outcome in patients with atrial fibrillation. J Electrocardiol 2011; 44:673-7. [PMID: 21907998 DOI: 10.1016/j.jelectrocard.2011.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Indexed: 10/17/2022]
Abstract
Atrial fibrillation (AF) remains the most common arrhythmia encountered in clinical practice. Electrocardiogram (ECG)-based predictors of clinical outcome, however, have mostly been studied during sinus rhythm, whereas noninvasive risk stratification of patients with AF remains largely unexplored. Advances in ECG signal processing have led to the development of noninvasive methods of atrial fibrillatory rate (AFR) assessment using spatiotemporal QRST cancellation and time frequency analysis that demonstrated its predictive value for the outcome of pharmacologic and catheter-based interventions for AF. Recently, the prognostic value of AFR was evaluated in patients with congestive heart failure and indicated that reduced AFR may be an independent predictor of total and congestive heart failure-related mortality. A high degree of irregularity of the RR intervals during AF and its dependence on the modulation of the atrioventricular conduction rather than sinus node automaticity hampers the use of conventional heart rate variability approach in patients with AF. However, RR irregularity measures that can be applied to short-time ECG recordings appear to be promising predictors of clinical outcome.
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Affiliation(s)
- Pyotr G Platonov
- Lund University Hospital and The Center for Integrative Electrocardiology, Lund University, Lund, Sweden.
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23
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Abstract
Sudden cardiac death (SCD) is a leading cause of mortality in industrialized countries, and ventricular fibrillation and sustained ventricular tachycardia are the major causes of SCD. Although there are now effective devices and medications that can prevent such serious arrhythmias, it is crucial to have methods of identifying patients at risk. Numerous studies suggest that most patients dying of SCD have coronary artery disease or cardiomyopathy. Functional or electrophysiological measurements are effective in risk stratification. Left ventricular ejection fraction measured by echocardiography or cardiac imaging techniques is the gold standard to detect high-risk patients. Electrophysiological studies have also been used for risk stratification. Noninvasive techniques and measurements, such as T-wave alternans, signal-averaged electrocardiography, nonsustained ventricular tachycardia, heart rate variability, and heart rate turbulence, have been proposed as useful tools in identifying patients at risk for SCD. This article reviews the epidemiology, mechanisms, substrates, and current status of risk stratification of SCD.
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Affiliation(s)
- Takanori Ikeda
- Second Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan.
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24
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Llaguno M, Pertili LARDR, da Silva MV, Bunazar P, Reges AM, Faleiros ACG, Lages-Silva E, Rodrigues Junior V, da Silva VJD, Correia Filho D. The relationship between heart rate variability and serum cytokines in chronic chagasic patients with persistent parasitemia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:724-35. [PMID: 21276024 DOI: 10.1111/j.1540-8159.2010.03025.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Persistent parasitemia, immunological, and autonomic nervous system impairments may play an important role in the evolution and clinical outcome of the chronic phase of Chagas' disease by triggering functional cardiovascular changes. METHODS Three groups were evaluated: 17 chronic chagasic patients with the indeterminate form (IChD), 12 chronic chagasic patients with cardiac forms (ChHD), and 29 individuals as a healthy control group. Parasitemia was assessed by polymerase chain reaction; hemoculture, heart rate variability by linear and nonlinear methods, and interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-12, IL-13, IL-17, and tumor necrosis factor-α, and interferon (IFN)-γ serum cytokines were assessed by enzyme-linked immune assay. RESULTS Twenty-nine chronic chagasic patients were positive for parasitemia (17 IChD and 12 ChHD). Heart rate variability parameters in baseline condition and after cold face test were significantly decreased in chagasic patients compared to controls. Tilt tests showed no alteration. However, using nonlinear indices, ChHD patients presented lower values compared to IChD and controls. Differences in the expression of serum cytokines were observed between chagasic patients and controls. However, among the groups, ChHD presented higher median values of IL-10 and lower of IFN-γ compared to IChD. CONCLUSION Both chagasic groups present an autonomic impairment using linear methods. The nonlinear methods revealed that the ChHD group had a higher cardiovascular risk. Serum cytokine concentrations between chagasic patients were similar. However, ChHD showed higher concentrations of IL-10 and lower of IFN-γ, suggesting some established process of immune regulation.
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Affiliation(s)
- Mauricio Llaguno
- Internal Medicine Department, Infectious Division, Federal University of the Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
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25
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Abstract
Individuals often eat calorically dense, highly palatable "comfort" foods during stress for stress relief. This article demonstrates that palatable food intake (limited intake of sucrose drink) reduces neuroendocrine, cardiovascular, and behavioral responses to stress in rats. Artificially sweetened (saccharin) drink reproduces the stress dampening, whereas oral intragastric gavage of sucrose is without effect. Together, these results suggest that the palatable/rewarding properties of sucrose are necessary and sufficient for stress dampening. In support of this finding, another type of natural reward (sexual activity) similarly reduces stress responses. Ibotenate lesions of the basolateral amygdala (BLA) prevent stress dampening by sucrose, suggesting that neural activity in the BLA is necessary for the effect. Moreover, sucrose intake increases mRNA and protein expression in the BLA for numerous genes linked with functional and/or structural plasticity. Lastly, stress dampening by sucrose is persistent, which is consistent with long-term changes in neural activity after synaptic remodeling. Thus, natural rewards, such as palatable foods, provide a general means of stress reduction, likely via structural and/or functional plasticity in the BLA. These findings provide a clearer understanding of the motivation for consuming palatable foods during times of stress and influence therapeutic strategies for the prevention and/or treatment of obesity and other stress-related disorders.
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26
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Liew R, Chiam PTL. Risk Stratification for Sudden Cardiac Death after Acute Myocardial Infarction. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n3p237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Many patients who survive an acute myocardial infarction (AMI) remain at risk of recurrent cardiac events and sudden cardiac death after discharge, despite optimal medical treatment. Assessment of the degree of left ventricular dysfunction and residual myocardial ischaemia is useful to identify the patients at greatest risk. In addition, there is increasing evidence that a number of other cardiovascular tests can be used to detect autonomic dysfunction and myocardial substrate abnormalities postAMI that increase the risk of life-threatening ventricular arrhythmias. These investigations include ECG-based tests (signal averaged ECG and T-wave alternans), Holter-based recordings (heart rate variability and heart rate turbulence) and imaging techniques echocardiography and cardiac magnetic resonance), as well as invasive electrophysiological testing. This article reviews the current evidence for the use of these additional cardiac investigations among survivors of AMI to aid in their risk stratification for malignant ventricular arrhythmias and sudden cardiac death.
Key words: Electrophysiological study, Holter recording, Non-invasive tests, Ventricular tachycardia
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Rutjanaprom W, Kanlop N, Charoenkwan P, Sittiwangkul R, Srichairatanakool S, Tantiworawit A, Phrommintikul A, Chattipakorn S, Fucharoen S, Chattipakorn N. Heart rate variability in beta-thalassemia patients. Eur J Haematol 2009; 83:483-9. [DOI: 10.1111/j.1600-0609.2009.01314.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Presumed arrhythmic death in consecutive survivors of acute myocardial infarction--implications for primary implantable cardioverter defibrillator implantation. Coron Artery Dis 2009; 20:155-62. [PMID: 19238081 DOI: 10.1097/mca.0b013e3283292b0e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM To describe the occurrence of arrhythmic death among survivors of acute myocardial infarction (AMI) and the availability of a primary implantable cardioverter defibrillator (ICD). METHODS Consecutive patients who fulfilled the criteria for AMI admitted to the Sahlgrenska University Hospital during 21 months were prospectively followed for 2 years with a focus on echocardiography and mode of death. RESULTS Among the 471 patients, for whom information on ejection fraction (EF) was available and who survived the first week, 10 patients died between days 7 and 30 - of whom one had an arrhythmic death. Among the 461 survivors on day 30, 34 patients (7.4%) had an EF of 30% or less. Among these, 24 were judged to be available for ICD implantation, of whom one died an arrhythmic death during follow-up. Among the remaining 10 patients who were excluded from ICD indication because of either high age and/or severe comorbidity, two patients died an arrhythmic death. Among the remaining 427 patients who had an EF greater than 30%, six died an arrhythmic death. Thus, 10 patients, with EF assessed, died an arrhythmic death between day 7 and 2 years after AMI, but only one would have received an ICD according to the Multicenter Automatic Defibrillator Implantation Trial II criteria and clinical judgement. CONCLUSION Of the 471 consecutive survivors of AMI, 10 (2%) died an arrhythmic death, of whom only one would have received an ICD according to current guidelines and clinical judgement. Predictors of subsequent arrhythmic death after an AMI, useful on a per patient basis, remain an unmet need.
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Saksena S, Nagarakanti R. The future of implantable defibrillator and cardiac resynchronization therapy trials. J Interv Card Electrophysiol 2008; 23:29-39. [DOI: 10.1007/s10840-008-9302-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Accepted: 07/08/2008] [Indexed: 11/29/2022]
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30
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Ding L, Hua W, Niu H, Chen K, Zhang S. Primary prevention of sudden cardiac death using implantable cardioverter defibrillators. Europace 2008; 10:1034-41. [PMID: 18559335 DOI: 10.1093/europace/eun150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Despite substantial advances in prevention and treatment of cardiovascular diseases, sudden cardiac death (SCD) remains a leading cause of death in industrialized countries. Implantable cardioverter defibrillator (ICD) has been demonstrated to be an attractive option for primary prevention of SCD in high-risk patients. This review discusses the progress in the risk stratification for selecting high-risk patients, highlights the clinical trials of primary prevention for SCD, outlines the efficacy of combined use of cardiac resynchronization therapy with ICD, and analyses the cost-effectiveness issue of this device.
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Affiliation(s)
- Ligang Ding
- Center of Arrhythmia, Fuwai Cardiovascular Hospital, Peking Union Medical College, Beijing, China
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31
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Kreuz J, Lickfett LM, Schwab JO. Modern noninvasive risk stratification in primary prevention of sudden cardiac death. J Interv Card Electrophysiol 2008; 23:23-8. [PMID: 18493844 DOI: 10.1007/s10840-008-9264-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 04/09/2008] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Since the publication of MADIT II and SCD-HeFT, an implantable cardioverter defibrillator (ICD) for primary prevention represents an established, guideline-implemented therapeutic strategy. Facing such an enormous amount of potential ICD recipients, the identification of an effective risk stratification remains crucial. METHODS This article reviews the tools of noninvasive risk stratification which are currently used and defines an optimal test configuration. This analysis focuses on the capacity of the tests regarding to the negative predictive value to reduce unneeded devices. RESULTS Presently, no marker exists in terms of risk stratification which qualifies itself as gold standard. However, encouraging results can be stated for microvolt T-wave alternans (mTWA) providing a high negative predictive value. An increased QT variability (QTv) and an impaired deceleration capacity are associated with an excellent positive predictive value. Currently, only mTWA and QTv seem to be suitable in ischemic and non-ischemic disease, but available data, especially in non-ischemic patients, are too small to provide clear recommendations. CONCLUSION The most hopeful tools at hand in modern noninvasive risk evaluation of sudden cardiac death in primary prevention seem to be mTWA and QTv. These noninvasive methods provide the best negative predictive or positive predictive value of all known parameters, while a higher rate of complete coronary revascularizations in acute coronary syndromes might also reduce the number of fatal arrhythmic events and therefore complicate the invention of an ideal risk marker.
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Affiliation(s)
- J Kreuz
- Department of Medicine-Cardiology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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Tanabe T. Circadian Distribution and Autonomic Tone Modulation in Paroxysmal Atrial Fibrillation. J Arrhythm 2008. [DOI: 10.1016/s1880-4276(08)80019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Among patients with cardiac disease, the identification of those who are at low risk and those who are at high risk for major cardiac events is crucial for a rational clinical management of individual patients. A correct noninvasive risk stratification of cardiac patients, in particular, has relevant clinical implications because it would avoid unnecessary exposure to potentially risky invasive diagnostic or interventional procedures in low-risk patients, whereas it would allow an appropriate aggressive diagnostic and therapeutic approach in high-risk patients. Furthermore, the appropriate identification of low- and high-risk patients would also have social and economic implications by favoring optimization of resource distribution and costs. A large number of studies in previous decades provided evidence that several methods and variables derived from the analysis of the electrocardiogram (ECG) are powerful predictors of major cardiac events in several clinical conditions. Despite that, there has been limited attention about how several of these findings can be used in clinical practice. Furthermore, in recent years, most studies about risk stratification of cardiac patients have mainly been focused on the use of a number of serum/plasma biomarkers with reduced attention to ECG variables. Surprisingly, however, there have been few attempts to establish whether the various proposed risk markers add any significant information to that obtainable from ECG methods. In this article, the evidence for the prognostic value of variables derived from the assessment of the ECG signal by several methods and techniques will be briefly reviewed. Because of the largeness of the topic, this review will be necessarily incomplete. Because most of the clinical research in this field concerned risk stratification of patients with coronary artery disease, the article will be largely focused on this population of patients. The role of ECG methods in specific cardiac diseases and, in particular, in the general population of asymptomatic subjects will be briefly discussed when believed appropriate and helpful. Furthermore, only major clinical events (ie, cardiac death, arrhythmic events, acute myocardial infarction) will be taken into account as end points in this article. Minor clinical events (eg, coronary revascularization procedures, coronary artery restenosis, recurrences of symptoms) are indeed less robust as end points because they are widely biased by subjective judgments.
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Fung JWH, Yu CM. Implantable cardiac resynchronization therapy devices to monitor heart failure clinical status. Curr Heart Fail Rep 2007; 4:48-52. [PMID: 17386186 DOI: 10.1007/s11897-007-0026-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiac resynchronization therapy is a standard therapy for selected patients with heart failure. With advances in technology and storage capacity, the device acts as a convenient platform to provide valuable information about heart failure status in these high-risk patients. Unlike other modalities of investigation which may only allow one-off evaluation, heart failure status can be monitored by device diagnostics including heart rate variability, activity status, and intrathoracic impedance in a continuous basis. These parameters do not just provide long-term prognostic information but also may be useful to predict upcoming heart failure exacerbation. Prompt and early intervention may abort decompensation, prevent hospitalization, improve quality of life, and reduce health care cost. Moreover, this information may be applied to titrate the dosage of medication and monitor response to heart failure treatment. This review will focus on the prognostic and predictive values of heart failure status monitoring provided by these devices.
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Affiliation(s)
- Jeffrey Wing-Hong Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Chattipakorn N, Incharoen T, Kanlop N, Chattipakorn S. Heart rate variability in myocardial infarction and heart failure. Int J Cardiol 2007; 120:289-96. [PMID: 17349699 DOI: 10.1016/j.ijcard.2006.11.221] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 11/20/2006] [Accepted: 11/21/2006] [Indexed: 12/11/2022]
Abstract
The need to refine the identification of patients who might benefit from implantation of an implantable cardioverter defibrillator has been risen by the results of many clinical trials on ICD therapy. Traditional parameters such as left ventricular ejection fraction and the presence of non-sustained ventricular tachycardia were not strong enough to achieve this goal with reasonable cost-effectiveness. Heart rate variability (HRV) is one of the most popular parameters used to assess the autonomic tone. HRV has been reported as a strong predictor of cardiovascular mortality. Currently, three different categories of methods in HRV analysis are being used; the time domain, frequency domain, and non-linear dynamic analysis. Both time domain and frequency domain analyses of HRV have been investigated extensively regarding their use as a prognostic marker for cardiovascular mortality. The non-linear dynamic analysis is the latest tool that has shown to have an even higher predictive value than any of the traditional parameters. However, standardized and supporting evidence on this new technique is still lacking. In this article, the current role of HRV in the prediction of cardiovascular mortality in myocardial infarction and heart failure patients has been reviewed.
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Affiliation(s)
- Nipon Chattipakorn
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Lüderitz B. A. John Camm. Clin Cardiol 2006; 26:251-3. [PMID: 12769256 PMCID: PMC6654611 DOI: 10.1002/clc.4960260512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Berndt Lüderitz
- Department of Medicine/Cardiology, University of Bonn, Bonn, Germany
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Ikeda T, Yoshino H, Sugi K, Tanno K, Shimizu H, Watanabe J, Kasamaki Y, Yoshida A, Kato T. Predictive value of microvolt T-wave alternans for sudden cardiac death in patients with preserved cardiac function after acute myocardial infarction: results of a collaborative cohort study. J Am Coll Cardiol 2006; 48:2268-74. [PMID: 17161258 DOI: 10.1016/j.jacc.2006.06.075] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 05/23/2006] [Accepted: 06/19/2006] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We conducted a collaborative cohort study to evaluate the predictive power of microvolt T-wave alternans (TWA) in patients with preserved left ventricular ejection fraction (LVEF) after myocardial infarction (MI). BACKGROUND There is little information available about the prognostic value of risk stratification markers in this population. Although these patients have a relatively good prognosis, identifying high-risk patients is important in clinical practice. METHODS This study enrolled 1,041 post-MI patients with an LVEF > or =40% (average 55 +/- 10%). Microvolt TWA testing was performed 48 +/- 66 days after acute MI, and 10 other risk variables were also evaluated. The end points were prospectively defined as sudden cardiac death or life-threatening arrhythmic events. RESULTS During a follow-up of 32 +/- 14 months, 38 patients (3.7%) died of nonarrhythmic causes and were not considered for analysis. Of the 1,003 evaluable patients, 18 (1.8%) reached an end point. Microvolt TWA was positive in 169 patients (17%), negative in 747 (74%), and indeterminate in 87 (9%). A positive microvolt TWA test, nonsustained ventricular tachycardia, and ventricular late potentials were predictors of events, and percutaneous coronary intervention decreased the risk rate. On multivariate analysis, a positive microvolt TWA test was the most significant predictor, with a hazard ratio of 19.7 (p < 0.0001). This marker had the highest sensitivity and negative predictive value for events. CONCLUSIONS In patients with preserved cardiac function, the incidence of indeterminate results of microvolt TWA is low, and a positive test result is associated with arrhythmic events. Microvolt TWA could be used for risk stratification in this low-risk population.
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Affiliation(s)
- Takanori Ikeda
- Second Department of Internal Medicine, Kyorin University, Tokyo, Japan.
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Budeus M, Feindt P, Gams E, Wieneke H, Erbel R, Sack S. Risk factors of ventricular tachyarrhythmias after coronary artery bypass grafting. Int J Cardiol 2006; 113:201-8. [PMID: 16330114 DOI: 10.1016/j.ijcard.2005.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Revised: 09/22/2005] [Accepted: 11/05/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ventricular arrhythmias are rare and represent the most serious arrhythmic complication after coronary artery bypass grafting (CABG). METHODS The present retrospective study was conducted for identifying patients at risk of ventricular arrhythmias with ventricular signal averaged ECG, standard deviation of all normal RR intervals (SDNN), angiographic and echocardiographic data. We defined ventricular arrhythmias as sustained ventricular fibrillation and ventricular tachycardia. The study population consisted of 209 consecutive patients with sinus rhythm undergoing CABG. The primary endpoint was the occurrence of VA after CABG. The secondary endpoints were hospital length of stay after CABG and the occurrence of VA after hospital discharge. RESULTS During the postoperative follow-up ventricular arrhythmias were observed in 11 patients (5%). Patients with ventricular arrhythmias showed a higher incidence of ventricular late potentials (91 vs. 9% of patients, p<0.0001) than patients without ventricular arrhythmias. In addition patients with ventricular arrhythmias had a lower left ventricular ejection fraction (44.2+/-15.2 vs. 60.1+/-13.1%, p<0.0001) and a SDNN (22.4+/-8.8 vs. 34.4+/-16.1 ms, p<0.02). A stepwise logistic regression analysis of all variables identified the combination of ventricular late potentials, ejection fraction < or = 38% and SDNN < or = 28 ms (odds rate 26.00; 95% CI, 3.44-196.67, p<0.002) as an independent predictor of ventricular arrhythmias. CONCLUSIONS The results of our study suggest that the probability of ventricular arrhythmias could be predicted after CABG by a combination of low left ventricular ejection fraction and a measurement of ventricular signal averaged ECG and standard deviation of all normal RR intervals. Patients who can be identified as having a high risk of ventricular arrhythmias should be observed carefully after surgery.
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Affiliation(s)
- Marco Budeus
- Department of Cardiology, West-German Heart Centre, University of Duisburg-Essen, Hufelandstr. 55, D-45122 Essen, Germany.
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247-346. [PMID: 16949478 DOI: 10.1016/j.jacc.2006.07.010] [Citation(s) in RCA: 863] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e385-484. [PMID: 16935995 DOI: 10.1161/circulationaha.106.178233] [Citation(s) in RCA: 807] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Arya A, Haghjoo M, Sadr-Ameli MA. Risk stratification for arrhythmic death after myocardial infarction: Current perspective and future direction. Int J Cardiol 2006; 108:155-64. [PMID: 15964087 DOI: 10.1016/j.ijcard.2005.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Revised: 03/16/2005] [Accepted: 05/14/2005] [Indexed: 10/25/2022]
Abstract
The number of patients eligible for implantable cardioverter defibrillator implantation is large and growing. Results of the Multicenter Automatic Defibrillator Implantation Trial-II, Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure trial, and Sudden Cardiac Death in Heart Failure Trial will have a major impact on health care expenditure and economics in all countries. Therefore, one of the most important challenges in today's cardiology is finding more specific and accurate risk stratification strategies (rather than simply ejection fraction) for primary prevention of sudden cardiac death in patients who have suffered myocardial infarction. We hereby reviewed the existing data on potential risk stratifiers and assessed their impact on every day decision making and patient selection for ICD implantation.
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Affiliation(s)
- Arash Arya
- Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical Center, Mellat Park, Vali-Asr Avenue, Tehran, 1996911151, Iran.
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Sassi R, Cerutti S, Hnatkova K, Malik M, Signorini MG. HRV Scaling Exponent Identifies Postinfarction Patients Who Might Benefit From Prophylactic Treatment With Amiodarone. IEEE Trans Biomed Eng 2006; 53:103-10. [PMID: 16402609 DOI: 10.1109/tbme.2005.859806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Analysing the Holter recordings collected at baseline during the European Myocardial Infarction Amiodarone Trial (EMIAT), we evaluate the possibility of using alpha, the slope of the power spectrum of heart rate variability signals (HRV) in the vicinity of f = 0, for postinfarction risk stratification. We found no relevant difference in the values of alpha for the placebo population. On the contrary, in the amiodarone arm, the distinction in the survival rates of those with high or low alpha-values was highly significant. Moreover, high risk patients with respect to alpha (higher values) did not seem to benefit from amiodarone. The results suggest that alpha might convey physiologic information that is different than what is expressed by other HRV characteristics, such as the triangular index. When combining high risk patients in term of triangular index (<20) and low risk patients with respect to alpha (<median), the difference in survival on placebo and amiodarone became very substantial (24.2% mortality on placebo, 8.7% on amiodarone, p = 0.017). This might offer a possibility of selecting patients likely to benefit from a prophylactic antiarrhythmic treatment after acute myocardial infarction.
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Affiliation(s)
- Roberto Sassi
- Dipartimento di Bioingegneria, Politecnico di Milano, Italy.
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Abstract
Electrocardiographic RR intervals fluctuate cyclically, modulated by ventilation, baroreflexes, and other genetic and environmental factors that are mediated through the autonomic nervous system. Short term electrocardiographic recordings (5 to 15 minutes), made under controlled conditions, e.g., lying supine or standing or tilted upright can elucidate physiologic, pharmacologic, or pathologic changes in autonomic nervous system function. Long-term, usually 24-hour recordings, can be used to assess autonomic nervous responses during normal daily activities in health, disease, and in response to therapeutic interventions, e.g., exercise or drugs. RR interval variability is useful for assessing risk of cardiovascular death or arrhythmic events, especially when combined with other tests, e.g., left ventricular ejection fraction or ventricular arrhythmias.
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Bennett AJ, DePetrillo PB. Differential Effects of MK801 and Lorazepam on Heart Rate Variability in Adolescent Rhesus Monkeys (Macaca Mulatta). J Cardiovasc Pharmacol 2005; 45:383-8. [PMID: 15821432 DOI: 10.1097/01.fjc.0000156820.12339.db] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Previous research shows that ketamine significantly alters cardiac signal regulation in rhesus monkeys, however relatively little is known about the mechanism for this effect. In the study reported here the relative contributions of NMDA receptor activation on cardiac signal dynamics were determined by administering a specific NMDA antagonist, MK801, to rhesus monkeys. The general effects of sedation were assessed by measuring cardiac response to lorazepam, a sedative drug without direct NMDA receptor activity. Electrocardiographic signal dynamics were examined before and after I.V. administration of either MK801 (0.16 mg/kg) or lorazepam (0.48 mg/kg). Inter-beat interval time series data were analyzed in the frequency domain after Fourier transform, and a nonlinear measure of autocorrelation, the Hurst exponent (H), was derived. After MK801 administration, log [HF /Total power] increased post-infusion (M = 1.11, SD = 0.45) compared with pre-infusion values [M = -0.19, SD = 0.32, F(1,4) = 19.49, P = 0.01] while H decreased, mean pre versus post 0.52+/-S.D. 0.10 versus 0.01+/- 0.05, P = 0.0002. Lorazepam administration did not significantly alter heart rate variability measures obtained in the frequency or nonlinear domains. To our knowledge, this is the first study that has defined the effects of peripherally administered MK801 on cardiovascular dynamics in primates and establishes that peripheral administration of NMDA antagonists result in large increases the high-frequency components of cardiac rhythm and increased heart rate variability compatible with MK801-associated increases in parasympathetic outflow.
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Affiliation(s)
- Allyson J Bennett
- Department of Physiology/Pharmacology and Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Batchvarov VN, Hnatkova K, Poloniecki J, Camm AJ, Malik M. Prognostic value of heterogeneity of ventricular repolarization in survivors of acute myocardial infarction. Clin Cardiol 2005; 27:653-9. [PMID: 15562938 PMCID: PMC6654101 DOI: 10.1002/clc.4960271115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The expansion of indications for implantation of cardioverter-defibrillators (ICD) has enhanced the need for risk stratification of patients post myocardial infarction (MI), while the improved treatment of acute MI has decreased mortality and diminished the prognostic power of traditional risk variables. HYPOTHESIS Increased heterogeneity of ventricular repolarization quantified by TCRT (total cosine R-to-T, angular difference between spatial QRS and T loops, decreased with increase in repolarization heterogeneity) is an independent predictor of mortality in patients post MI. METHODS Left ventricular ejection fraction (EF), QRS duration on signal-averaged ECG, number of ventricular ectopic beats (VE)/h, heart rate variability (HRV) triangular index, heart rate turbulence slope on 24-h Holter recording, and TCRT were analyzed in 334 survivors of acute MI followed up for 41 +/- 20 months. RESULTS In multivariate analysis, EF < 35% (relative risk [RR] 2.3, 95% confidence interval [CI] 1.1-4.7, p = 0.023), VE > 10/h (RR 2.2, CI 1.0-4.6, p = 0.044), HRV < 20 U (RR 2.2, CI 1.1-4.5, p = 0.032), and TCRT < -0.896 (RR 4.3, CI 2.2-8.5, p = 0.00001) were independent predictors of cardiac mortality (11%). Independent predictors of arrhythmic mortality (5%) were VE, HRV, and TCRT (RR 5.8, CI 2.1-15.6, p = 0.0004). Cardiac and arrhythmic mortality of patients with both EF <35% and TCRT < -0.896 were >60 and >30%, respectively, compared with 17 and 7% in those with only EF <35% or TCRT < -0.896. CONCLUSION Decreased TCRT, which reflects increased repolarization heterogeneity, is a strong and independent predictor of cardiac and arrhythmic death in patients post MI.
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Affiliation(s)
- Velislav N Batchvarov
- Department of Cardiac and Vascular Sciences, St. George's Hospital Medical School, London, England.
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Cosić Z, Tavcioski D, Jovelić A, Romanović R. Late ventricular potentials in risk assessment of the occurrence of complex ventricular arrhythmia in patients with myocardial infarction and heart failure. VOJNOSANIT PREGL 2005; 61:589-97. [PMID: 15717719 DOI: 10.2298/vsp0406589c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIM To determine the prognostic significance of late ventricular potentials on signal-averaged electrocardiogram and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmia in patients treated with accelerated tissue-type plasminogen activator, using the rapid protocol, within six months of acute myocardial infarction. METHODS In this analytic observational prospective study patients were divided into four groups: patients with left ventricular ejection fraction bellow 40% and late ventricular potentials, patients with left ventricular ejection fraction bellow 40% and without late ventricular potentials, patients with left ventricular ejection fraction over 40% and late ventricular potentials, and patients with left ventricular ejection fraction over 40% and without late ventricular potentials. Complex ventricular arrhythmias (Lown grade IVa, IVb, and V) were recorded using standard electrocardiography and 24-hour Holter monitoring 21, 60, and 90 days after acute myocardial infarction, respectively. Serial recordings of signal-averaged electrocardiogram were obtained 30, 90, and 180 days after acute myocardial infarction. Left ventricular ejection fraction was determined by echocardiography between 15 and 21 days after acute myocardial infarction. Multivariant logistic regression analysis was used to evaluate the relation between late ventricular potentials and left ventricular ejection fraction with the occurrence of complex ventricular arrhythmias. Sensitivity, specificity, positive and negative predictive values of late ventricular potentials and left ventricular ejection fraction for the occurrence of complex ventricular arrhythmias were determined. RESULTS The prospective study included 80 patients (73% men), mean age 64 +/- 3.5 years. Complex ventricular arrhythmias were recorded in 34 (42.5%) of patients, all 17 (50%) of which were from the first group (p < 0.01). Complex ventricular arrhythmias were recorded in 25 (73.5%) patients with late ventricular potentials, and in 23 (67.6%) patients with left ventricular ejection fraction bellow 40%. Left ventricular ejection fraction bellow 40% and late ventricular potentials represented independent predictors for the occurrence of complex ventricular arrhythmias (RR = 14.33, p < 0.01). When combined with left ventricular ejection fraction bellow 40%, late ventricular potentials had sensitivity (0.50), specificity (0.93), and positive predictive accuracy (0.85) higher than late ventricular potentials alone (0.44, 0.67, and 0.37, respectively) for the occurrence of complex ventricular arrhythmias following acute myocardial infarction. CONCLUSION In this study, late ventricular potentials in patients with left ventricular ejection fraction bellow 40% represented the independent predictor for the occurrence of complex ventricular arrhythmias in the first six months after the first myocardial infarction treated with accelerated tissue-type plasminogen activator, using the rapid protocol.
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Affiliation(s)
- Zoran Cosić
- Military Medical Academy, Clinic of Cardiology, Belgrade.
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Smetana P, Pueyo E, Hnatkova K, Batchvarov V, Laguna P, Malik M. Individual Patterns of Dynamic QT/RR Relationship in Survivors of Acute Myocardial Infarction and Their Relationship to Antiarrhythmic Efficacy of Amiodarone. J Cardiovasc Electrophysiol 2004; 15:1147-54. [PMID: 15485438 DOI: 10.1046/j.1540-8167.2004.04076.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Amiodarone is an effective antiarrhythmic drug, but it has serious side effects and conducted trials did not support its prophylactic use in survivors of acute myocardial infarction. It is possible that the prophylactic use of the drug has not been tested effectively. To optimize therapy outcome, markers of drug efficacy might be developed to identify patients who, although at arrhythmic risk, would not benefit from amiodarone treatment. We investigated descriptors of QT/RR relationship for their potential value in predicting inefficient amiodarone treatment. METHODS AND RESULTS The study used 866 Holter recordings (462 amiodarone, 404 placebo) obtained 1 month after randomization in the European Myocardial Infarct Amiodarone Trial (EMIAT). A commercial Holter system was used to measure RR and QT intervals. Subject-specific descriptors of QT/RR relationship were calculated. Comparison was performed in amiodarone- and placebo-treated patients, distinguishing patients who did and did not suffer from arrhythmic death. QT/RR relationship and individually corrected QTc interval differed significantly, not only between amiodarone- and placebo-treated postmyocardial infarction patients but also between patients with and without arrhythmic death on amiodarone (QTc with vs without arrhythmic death 426.30 +/- 33.93 ms vs 444.23 +/- 36.65 ms, P = 6.5 x 10(-3)). In a multivariate analysis, reduced optimum regression residuum (14.33 +/- 7.08 vs 20.11 +/- 9.39, P = 4.4 x 10(-3)) and flatter slope (0.44 +/- 0.19 vs 0.55 +/- 0.24, P = 4.0 x 10(-2)) of the QT/RR relationship independently predicted arrhythmic death during follow-up. CONCLUSION Chronic amiodarone treatment markedly affects the QT/RR relationship. The lack of treatment-related QT/RR changes predicts arrhythmic death. Descriptors of complexity of QT/RR relation seem to be potent markers of treatment efficiency.
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Affiliation(s)
- Peter Smetana
- Department of Cardiac and Vascular Sciences, St. George's Hospital Medical School, London, England
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Kuch B, Parvanov T, Hense HW, Axmann J, Bolte HD. Short-period heart rate variability in the general population as compared to patients with acute myocardial infarction from the same source population. Ann Noninvasive Electrocardiol 2004; 9:113-20. [PMID: 15084207 PMCID: PMC6932148 DOI: 10.1111/j.1542-474x.2004.92523.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Our aim was to compare the distribution and determinants of heart rate variability (HRV) measures in a middle-aged population with patients of the same sex and age after an acute myocardial infarction (AMI), and to show, whether HRV values defined as abnormal from the general population are indicative for a worse prognosis even in AMI patients. METHODS HRV was studied in a random sample of 149 middle-aged men and 137 women from the general population (45-65 years) as well as 129 consecutive AMI patients (25-74 years). Spectral analysis was used to compute low frequency (LF), high frequency (HF), and total frequency power. To the AMI population of age 45-65 years (N = 85) a sample out of the general population was matched by age and sex by 2:1 matching (N = 149). All AMI patients were followed for a median of 43 months (range 1-47) for death or malignant arrhythmia. RESULTS All measures of HRV were significantly and substantially lower in AMI patients than the general population (P < 0.001). Expression in relative terms revealed that the proportionate contributions of HF and LF to total power were significantly different in the two populations with relatively lower LF power in AMI patients (P < 0.01). The negative correlation with heart rate and HRV measures was significantly more pronounced in AMI patients (P < 0.01). The 2.5th percentile of the LF power distribution in the general population (3.08 ln ms2) corresponds to the 25th percentile in the AMI population. Subjects of the whole AMI population with values below this LF cutpoint revealed a significant increased risk of death or malignant arrhythmia during follow-up (odds ratio 5.1; 95% confidence interval: 1.3; 23). CONCLUSIONS AMI patients had strongly diminished HRV compared to the general population. The relatively lower LF power indicates an alteration of the sympathico-vagal balance, and the significantly stronger correlation of heart rate with HRV may be indicative for a more pronounced effect of sympathetic activation on autonomic modulation in the case of myocardial infarction. Finally, a value below the 2.5th percentile of the population LF power distribution may identify subjects at risk and warrant further testing.
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Affiliation(s)
- Bernhard Kuch
- Medizinische Klinik, Akademisches Lehrkrankenhaus der Ludwig Maximilians Universität München, Zentralklinikum Augsburg, Germany.
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Frenneaux MP. Autonomic changes in patients with heart failure and in post-myocardial infarction patients. Heart 2004; 90:1248-55. [PMID: 15486114 PMCID: PMC1768543 DOI: 10.1136/hrt.2003.026146] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2004] [Indexed: 11/04/2022] Open
Abstract
A range of techniques for the assessment of autonomic tone are described. Impaired baroreflex control of heart period, measured in terms of heart rate variability or baroreflex sensitivity, is independently associated with adverse prognosis in patients with heart failure and following acute myocardial infarction. These techniques have not yet entered routine clinical practice.
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Affiliation(s)
- M P Frenneaux
- Department of Cardiovascular Medicine, The Medical School, University of Birmingham, Edgbaston, Birmingham, UK.
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