Improved Stratification of Autonomic Regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-Risk).
Improved Stratification of Autonomic Regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-Risk).
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DOI：
10.1093/eurheartj/ehn540
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发表时间：
2009-03
影响因子：
39.3
通讯作者：
Schmidt G
中科院分区：
文献类型：
--
作者：
Bauer A;Barthel P;Schneider R;Ulm K;Müller A;Joeinig A;Stich R;Kiviniemi A;Hnatkova K;Huikuri H;Schömig A;Malik M;Schmidt G
探讨窦性心率震荡（HRT）和减速能力（DC）联合应用对心肌梗死后左室射血分数（LVEF）> 30%患者的危险预测作用。我们纳入了2343例窦性心律的急性心肌梗死（MI）（<76岁）连续幸存者。从24 h霍尔特记录中获得HRT和DC。HRT异常（斜率≤ 2.5 ms/RR且发作≥ 0%）和DC异常（≤4.5 ms）的患者被视为患有重度自主神经功能衰竭（SAF），并前瞻性归类为高风险。主要和次要终点是随访前5年内的全因死亡、心源性死亡和心源性猝死。随访期间，181例患者死亡; LVEF ≤ 30%的120例患者中有39例死亡，LVEF>30%的2223例患者中有142例死亡（累积5年死亡率分别为37.9%和7.8%）。在LVEF > 30%的患者中，SAF确定了另一个高风险组117例患者，其中37例死亡（累积5年死亡率分别为38.6%和6.1%）。合并两个高风险组（即LVEF ≤ 30%和/或SAF）与LVEF ≤ 30%相比，死亡率预测的灵敏度增加了一倍（21.1% vs. 42.1%，P < 0.001），同时保持了5年死亡率（38.2%）。在LVEF> 30%的MI后患者中，SAF确定了一个高风险组，其规模和死亡风险与LVEF ≤ 30%的患者相当。
To investigate the combination of heart rate turbulence (HRT) and deceleration capacity (DC) as risk predictors in post-infarction patients with left ventricular ejection fraction (LVEF) > 30%. We enrolled 2343 consecutive survivors of acute myocardial infarction (MI) (<76 years) in sinus rhythm. HRT and DC were obtained from 24 h Holter recordings. Patients with both abnormal HRT (slope ≤ 2.5 ms/RR and onset ≥ 0%) and abnormal DC (≤4.5 ms) were considered suffering from severe autonomic failure (SAF) and prospectively classified as high risk. Primary and secondary endpoints were all-cause, cardiac, and sudden cardiac mortality within the first 5 years of follow-up. During follow-up, 181 patients died; 39 deaths occurred in 120 patients with LVEF ≤ 30%, and 142 in 2223 patients with LVEF>30% (cumulative 5-year mortality rates of 37.9% and 7.8%, respectively). Among patients with LVEF > 30%, SAF identified another high-risk group of 117 patients with 37 deaths (cumulative 5-year mortality rates of 38.6% and 6.1%, respectively). Merging both high-risk groups (i.e. LVEF ≤ 30% and/or SAF) doubled the sensitivity of mortality prediction compared with LVEF ≤ 30% alone (21.1% vs. 42.1%, P < 0.001) while preserving 5-year mortality rate (38.2%). In post-MI patients with LVEF>30%, SAF identifies a high-risk group equivalent in size and mortality risk to patients with LVEF ≤ 30%.
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影响因子：
168.9
作者：
Bauer, Axel;Kantelhardt, Jan W.;Schmidt, Georg
通讯作者：
Schmidt, Georg
影响因子：
158.5
作者：
Hohnloser, SH;Kuck, KH;Connolly, SJ
通讯作者：
Connolly, SJ
影响因子：
158.5
作者：
Moss, AJ;Hall, WJ;Heo, M
通讯作者：
Heo, M
影响因子：
24
作者：
Chow, T;Kereiakes, DJ;Chan, PS
通讯作者：
Chan, PS
影响因子：
158.5
作者：
Buxton, AE;Lee, KL;Hafley, G
通讯作者：
Hafley, G