Increased non-gaussianity of heart rate variability predicts cardiac mortality after an acute myocardial infarction.
Increased non-gaussianity of heart rate variability predicts cardiac mortality after an acute myocardial infarction.
复制标题
DOI：
10.3389/fphys.2011.00065
复制
发表时间：
2011
影响因子：
4
通讯作者：
Carney RM
中科院分区：
文献类型：
--
作者：
Hayano J;Kiyono K;Struzik ZR;Yamamoto Y;Watanabe E;Stein PK;Watkins LL;Blumenthal JA;Carney RM
非高斯指数（λ）是心率变异性（HRV）的一个新的指标，它表征心率偏离其趋势的概率增加。先前的一项研究报道，λ增加是慢性心力衰竭患者的独立死亡预测因子。本研究探讨了λ在急性心肌梗死（AMI）患者中的预测价值。对670例AMI后患者进行24小时霍尔特监测，以评估λ和其他HRV预测指标，包括正常-正常间期SD、极低频功率、去趋势波动分析的标度指数α1、减速能力和心率震荡（HRT）。在基线时，λ与其他HRV指标无显著相关性（|R| < 0.4），服用β受体阻滞剂的患者降低（P = 0.04）。在25个月的中位随访期内，45例（6.7%）患者死亡（32例心源性和13例非心源性），39例复发性非致命性AMI发生在幸存者中。尽管除λ外的所有这些HRV指标都是心源性和非心源性死亡的显著预测因子，但λ增加仅预测心源性死亡（RR [95% CI]，每增加1 SD 1.6 [1.3-2.0]，P < 0.0001）。即使调整了临床风险因素，如年龄、糖尿病、左心室功能、肾功能、既往AMI、心力衰竭和卒中、Killip分级和治疗后，λ增加的预测能力也是显著的（[95% CI]，每1 SD增量1.4 [1.1-2.0]，P = 0.01）。心源性死亡的λ增加的预后能力也独立于所有其他HRV指标，并且λ增加和异常HRT的组合提供了心源性死亡的最佳预测模型。λ和其他HRV指标均不是AMI复发的独立预测因子。在AMI后患者中，λ增加仅与心源性死亡风险增加相关，其预测能力独立于临床危险因素和其他HRV预测因子。
Non-Gaussianity index (λ) is a new index of heart rate variability (HRV) that characterizes increased probability of the large heart rate deviations from its trend. A previous study has reported that increased λ is an independent mortality predictor among patients with chronic heart failure. The present study examined predictive value of λ in patients after acute myocardial infarction (AMI). Among 670 post-AMI patients, we performed 24-h Holter monitoring to assess λ and other HRV predictors, including SD of normal-to-normal interval, very-low frequency power, scaling exponent α1 of detrended fluctuation analysis, deceleration capacity, and heart rate turbulence (HRT). At baseline, λ was not correlated substantially with other HRV indices (|r| < 0.4 with either indices) and was decreased in patients taking β-blockers (P = 0.04). During a median follow-up period of 25 months, 45 (6.7%) patients died (32 cardiac and 13 non-cardiac) and 39 recurrent non-fatal AMI occurred among survivors. While all of these HRV indices but λ were significant predictors of both cardiac and non-cardiac deaths, increased λ predicted exclusively cardiac death (RR [95% CI], 1.6 [1.3–2.0] per 1 SD increment, P < 0.0001). The predictive power of increased λ was significant even after adjustments for clinical risk factors, such as age, diabetes, left ventricular function, renal function, prior AMI, heart failure, and stroke, Killip class, and treatment ([95% CI], 1.4 [1.1–2.0] per 1 SD increment, P = 0.01). The prognostic power of increased λfor cardiac death was also independent of all other HRV indices and the combination of increased λ and abnormal HRT provided the best predictive model for cardiac death. Neither λ nor other HRV indices was an independent predictor of AMI recurrence. Among post-AMI patients, increased λ is associated exclusively with increased cardiac mortality risk and its predictive power is independent of clinical risk factors and of other HRV predictors.
登录
查看更多内容
影响因子：
39.3
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
通讯作者：
Schmidt G
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：
--
作者：
SCHLEIFER, SJ;MACARIHINSON, MM;ZUCKER, HD
通讯作者：
ZUCKER, HD
影响因子：
2.4
作者：
Kiyono, Ken;Struzik, Zbigniew R.;Yamamoto, Yoshiharu
通讯作者：
Yamamoto, Yoshiharu
影响因子：
8.6
作者：
Kiyono, K;Struzik, ZR;Yamamoto, Y
通讯作者：
Yamamoto, Y