Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction:: cohort study
Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction:: cohort study
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DOI：
10.1016/s0140-6736(06)68735-7
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发表时间：
2006-05-20
期刊：
影响因子：
168.9
通讯作者：
Schmidt, Georg
中科院分区：
文献类型：
--
作者：
Bauer, Axel;Kantelhardt, Jan W.;Schmidt, Georg
背景心肌梗死后迷走神经活动减少导致心率变异性降低和死亡风险增加。为了区分影响心率变异性的迷走神经和交感神经因素，我们使用了一种信号处理算法来分别识别心率的减速和加速。我们假设心率减速相关调节减弱是一个重要的预后指标。我们的前瞻性假设是，减速能力是一个更好的预测风险比左心室射血分数（LVEF）和标准差的正常到正常的intervals（SDNN）。方法我们量化的心率减速能力评估24小时霍尔特记录梗死后队列在慕尼黑（n=1455）。我们在英国伦敦（n=656）和芬兰欧卢（n=600）的梗死后人群中盲法验证了减速能力的预后能力。我们测试了我们的假设，通过评估的面积下的受试者-操作者的特征曲线（AUC）。结果在中位随访24个月，70人死亡的慕尼黑队列和66在伦敦队列。对欧卢队列进行了38个月的随访，77人死亡。在伦敦队列中，减速能力的平均AUC为0.80（SD 0.03），而LVEF为0.67（0.04），SDNN为0.69（0.04）。在欧卢队列中，减速能力的平均AUC为0.74（0.03），而LVEF为0.60（0.04），SDNN为0.64（0.03）（p
Background Decreased vagal activity after myocardial infarction results in reduced heart-rate variability and increased risk of death. To distinguish between vagal and sympathetic factors that affect heart-rate variability, we used a signal-processing algorithm to separately characterise deceleration and acceleration of heart rate. We postulated that diminished deceleration-related modulation of heart rate is an important prognostic marker. Our prospective hypotheses were that deceleration capacity is a better predictor of risk than left-ventricular ejection fraction (LVEF) and standard deviation of normal-to-normal intervals (SDNN).Methods We quantified heart rate deceleration capacity by assessing 24-h Holter recordings from a post-infarction cohort in Munich (n=1455). We blindly validated the prognostic power of deceleration capacity in post-infarction populations in London, UK (n=656), and Oulu, Finland (n=600). We tested our hypotheses by assessment of the area under the receiver-operator characteristics curve (AUC).Findings During a median follow-up of 24 months, 70 people died in the Munich cohort and 66 in the London cohort. The Oulu cohort was followed-up for 38 months and 77 people died. In the London cohort, mean AUC of deceleration capacity was 0.80 (SD 0.03) compared with 0.67 (0.04) for LVEF and 0.69 (0.04) for SDNN. In the Oulu cohort, mean AUC of deceleration capacity was 0.74 (0.03) compared with 0.60 (0.04) for LVEF and 0.64 (0.03) for SDNN (p