Prognostic value of heart rate variability in post-infarction patients

Aneta Bošković; Nataša Belada; Božidarka Knežević

doi:10.2298/3833

Aneta Bošković Clinic of Cardiology, Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
Nataša Belada Clinic of Cardiology, Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
Božidarka Knežević Clinic of Cardiology, Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro

DOI: https://doi.org/10.2298/3833

Ključne reči: myocardial infarction||, ||infarkt miokarda, heart rate||, ||srce, frekvencija, arrhythmias, cardiac||, ||aritmija, mortality||, ||mortalitet, risk factors||, ||faktori rizika, predictive value of tests||, ||testovi, prognostička vrednost.,

Sažetak

Uvod/Cilj. Smanjena varijabilnost srčane frekvencije kao pokazatelj neuravnoteženosti autonomnog nervnog sistema i sklonosti ka ventrikularnim ekstrasistolama može biti korisna za stratifikaciju rizika kod bolesnika nakon akutnog infarkta miokarda. Cilj studije bio je da se ispita prognostički značaj varijabilnosti srčane frekvencije za ukupni mortalitet kod ovih bolesnika. Metode. Analizirali smo 24-časovno Holter elektrokardiografsko praćenje 100 bolesnika za vreme hospitalizacije zbog akutnog infarkta miokarda. Prosečna starost bolesnika bila je 56,99 + 11,03 godine, od kojih je bilo 80 muškaraca. Time domain analiza varijabilnosti srčane frekvencije određivana je od 8. do 13. dana od nastanka akutnog infarkta miokarda, uz upotrebu 24-časovnog Holter posmatranja, a izračunavani parametri bili su: standardna devijacija svih normalnih RR intervala (SDNN), RRmax-RRmin (razlika između najdužeg RR intervala i najkraćeg RR intervala) i prosečni RR interval. Iz Holter posmatranja, takođe, analizirani su ventrikularni poremećaji ritma. Kod bolesnika je obavljeno i kliničko praćenje, laboratorijski testovi i ehokardiografsko ispitivanje. Rezultati. Tokom perioda praćenja od godinu dana, 11 bolesnika je umrlo, od čega 10 zbog kardijalnog uzroka, a jedan usled cerebro-vaskularnog inzulta. Registrovane su značajno niže vrednosti SDNN (60,55 ± 12,84 ms vs 98,38 ± 28,21 ms), RRmax-RRmin (454,36 ± 111,00 ms vs 600,99 ± 168,72 ms) i prosečnog RR intervala (695,82 ± 65,87 ms vs 840,07 ± 93,97 ms) kod umrlih u odnosu na preživele (p < 0.01). Preminuli bolesnici bili su stariji, sa nižom ejekcionom frakcijom leve komore (0,46 ± 0,05 vs 0,56 ± 0,06), češćim kliničkim znacima srčane insuficijencije i ventrikularnim poremećajima ritma (> 10VES/h; p < 0,01). Multivarijantna Cox analiza pokazala je da je SDNN značajan, nezavisan prediktor za ukupni mortalitet kod bolesnika nakon infarkta miokarda. Drugi nezavisni prognostički faktori bili su klinički znaci srčane insuficijencije – Killip klasa II i III i učestale ventrikularne ekstrasistole. Zaključak. Smanjena varijabilnost srčane frekvencije je nezavisan prediktor mortaliteta kod bolesnika nakon infarkta miokarda i može pružiti korisne dodatne prognostičke informacije u neinvazivnoj stratifikaciji rizika kod ovih bolesnika

Reference

Andresen D, Steinbeck G, Brüggemann T, Müller D, Haberl R, Behrens S, et al. Risk stratification following myocardial infarction in the thrombolytic era: a two-step strategy using noninvasive and invasive methods. J Am Coll Cardiol 1999; 33(1): 131−8.

Volpi A, de Vita C, Franzosi MG, Geraci E, Maggioni AP, Mauri F, et al. Determinants of 6-month mortality in survivors of myocardial infarction after thrombolysis. Results of the GISSI-2 data base. The Ad hoc Working Group of the Gruppo Ita-liano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-2 Data Base. Circulation 1993; 88(2): 416−29.

Farrell TG, Bashir Y, Cripps T, Malik M, Poloniecki J, Bennett ED, et al. Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocar-diographic variables and the signal-averaged electrocardio-gram. J Am Coll Cardiol 1991; 18(3): 687−97.

La Rovere MT, Bigger JT, Marcus FI, Mortara A, Schwartz PJ. Ba-roreflex sensitivity and heart-rate variability in prediction of to-tal cardiac mortality after myocardial infarction. ATRAMI (Au-tonomic Tone and Reflexes After Myocardial Infarction) In-vestigators. Lancet 1998; 351(9101): 478−84.

Wolf MM, Varigos GA, Hunt D, Sloman JG. Sinus arrhythmia in acute myocardial infarction. Med J Aust 1978; 2(2): 52−3.

Task Force of the European Society of Cardiology and The North Amer-ican Society of Pacing and Electrophysiology. Heart rate variability Standards of measurement physiological interpretation and clinical use. Eur Heart J 1996; 17(3): 354−81.

Davis HT, DeCamilla J, Bayer LW, Moss AJ. Survivorship pat-terns in the posthospital phase of myocardial infarction. Circulation 1979; 60(6): 1252−8.

de Sousa MR, Morillo CA, Rabelo FT, Nogueira Filho AM, Ribeiro AL. Non-sustained ventricular tachycardia as a predictor of sudden cardiac death inpatients with left ventricular dys-function: a meta-analysis. Eur J Heart Fail 2008; 10(10): 1007−14.

Bastiaenen R, Batchvarov V, Gallagher MM. Ventricular automa-ticity as a predictor of sudden death in ischaemic heart disease. Europace 2012; 14(6): 795−803.

Kleiger RE, Miller JP, Bigger JT, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987; 59(4): 256−62.

Maggioni AP, Zuanetti G, Franzosi MG, Rovelli F, Santoro E, Stas-zewsky L, et al. Prevalence and prognostic significance of ven-tricular arrhythmias after acute myocardial infarction in the fi-brinolytic era. GISSI-2 results. Circulation 1993; 87(2): 312−22.

Buccelletti E, Gilardi E, Scaini E, Galiuto L, Persiani R, Biondi A, et al. Heart rate variability and myocardial infarction: systematic literature review and metanalysis. Eur Rev Med Pharmacol Sci 2009; 13(4): 299−307.

Garan H. Heart rate variability in acute myocardial infarction. Cardiology 2009; 114(4): 273−4.

Huikuri HV, Raatikainen PMJ, Moerch-Joergensen R, Hartikainen J, Virtanen V, Boland J, et al. Prediction of fatal or near-fatal car-diac arrhythmia events in patients with depressed left ventricu-lar function after an acute myocardial infarction. Eur Heart J 2009; 30(6): 689−98.

Bekheit S, Tangella M, Sakr A, Rasheed Q, Craelius W, Sherif N. Use of heart rate spectral analysis to study the effects of cal-cium channel blockers on sympathetic activity after myocardial infarction. Am Heart J 1990; 119(1): 79−85.

Coumel P, Hermida JS, Wennerblöm B, Leenhardt A, Maison-Blanche P, Cauchemez B. Heart rate variability in left ventricular hyper-trophy and heart failure, and the effects of beta-blockade. A non-spectral analysis of heart rate variability in the frequency domain and in the time domain. Eur Heart J 1991; 12(3): 412−22.

Foley PW, Addison CE, Whinney SB, Patel K, Cunningham D, Frenneaux MP, et al. Implantable cardioverter defibrillator ther-apy for primary prevention of sudden cardiac death after myocardial infarction: implications of international guidelines. Pacing Clin Electrophysiol 2009; 32 Suppl 1: S131−4.

Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33(20): 2569−619.

Verma A, Sarak B, Kaplan AJ, Oosthuizen R, Beardsall M, Wulffhart Z, et al. Predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in primary prevention patients with ischemic and nonischemic cardiomyopathy. Pacing Clin Elec-trophysiol 2010; 33(3): 320−9.

Lee DS, Green LD, Liu PP, Dorian P, Newman DM, Grant CF, et al. Effectiveness of implantable defibrillators for preventing arrhythmic events and death: a meta-analysis. J Am Coll Car-diol 2003; 41(9): 1573−82.

Catanchin A, Anderson L, Jones S, Ward D. When life-saving devices terminate life. J Cardiovasc Electrophysiol 2008; 19(3): 316−8.

Al-Khatib SM, Sanders GD, Bigger TJ, Buxton AE, Califf RM, Carlson M, et al. Preventing tomorrow's sudden cardiac death today: part I: Current data on risk stratification for sudden cardiac death. Am Heart J 2007; 153(6): 941−50.

Das MK, Maskoun W, Shen C, Michael MA, Suradi H, Desai M, et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 2010; 7(1): 74−80.

Steinbeck G, Andresen D, Seidl K, Brachmann J, Hoffmann E, Woj-ciechowski D, et al.. Defibrillator implantation early after myo-cardial infarction. N Engl J Med 2009; 361(15): 1427−36.

Gang UJ, Jøns C, Jørgensen RM, Abildstrøm SZ, Haarbo J, Messier MD, et al. Heart rhythm at the time of death documented by an implantable loop recorder. Europace 2010; 12(2): 254−60.

Goldberger JJ, Cain ME, Hohnloser SH, Kadish AH, Knight BP, Lauer MS, et al. American Heart Association/American Col-lege of Cardiology Foundation/Heart Rhythm Society scientif-ic statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention. Circulation 2008; 118(14): 1497−518.

Hohnloser SH, Kuck KH, Dorian P, Roberts RS, Hampton JR, Hata-la R, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 2004; 351(24): 2481−8.

Huikuri HV, Stein PK. Clinical application of heart rate varia-bility after acute myocardial infarction. Front Physiol 2012; 3: 41.

Prognostički značaj varijabilnosti srčane frekvencije kod bolesnika nakon infarkta miokarda

Sažetak

Reference