Limits...
Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction.

Huikuri HV, Raatikainen MJ, Moerch-Joergensen R, Hartikainen J, Virtanen V, Boland J, Anttonen O, Hoest N, Boersma LV, Platou ES, Messier MD, Bloch-Thomsen PE, Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction study gro - Eur. Heart J. (2009)

Bottom Line: The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms(2)) adjusted for clinical variables was 7.0 (95% CI: 2.4-20.3, P < 0.001).Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7-13.4, P = 0.003) also predicted the primary endpoint.Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Oulu, PO Box 5000, Kajaanintie 50, 90014 Oulu, Finland. heikki.huikuri@oulu.fi

ABSTRACT

Aims: To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF < or = 0.40).

Methods and results: A total of 5869 consecutive patients were screened in 10 European centres, and 312 patients (age 65 +/- 11 years) with a mean LVEF of 31 +/- 6% were included in the study. Heart rate variability/turbulence, ambient arrhythmias, signal-averaged electrocardiogram (SAECG), T-wave alternans, and programmed electrical stimulation (PES) were performed 6 weeks after AMI. The primary endpoint was ECG-documented ventricular fibrillation or symptomatic sustained ventricular tachycardia (VT). To document these arrhythmic events, the patients received an implantable ECG loop-recorder. There were 25 primary endpoints (8.0%) during the follow-up of 2 years. The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms(2)) adjusted for clinical variables was 7.0 (95% CI: 2.4-20.3, P < 0.001). Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7-13.4, P = 0.003) also predicted the primary endpoint.

Conclusion: Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI.

Show MeSH

Related in: MedlinePlus

Study Flow Chart. *Major reasons for exclusions from the study were refusal of the patient or the attending physician treating the patient for participation in the study (n = 380), the inability of the patient to participate in the study due to other serious illness (n = 312), planned coronary bypass graft surgery (n = 184) or death (n = 89) before the implantation of a loop-recorder and/or the risk stratification tests. AMI, acute myocardial infarction; EP, electrophysiological; ILR, implantable loop-recorder; SAECG, signal-averaged electrocardiogram; TWA, T-wave alternans.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2655314&req=5

EHN537F1: Study Flow Chart. *Major reasons for exclusions from the study were refusal of the patient or the attending physician treating the patient for participation in the study (n = 380), the inability of the patient to participate in the study due to other serious illness (n = 312), planned coronary bypass graft surgery (n = 184) or death (n = 89) before the implantation of a loop-recorder and/or the risk stratification tests. AMI, acute myocardial infarction; EP, electrophysiological; ILR, implantable loop-recorder; SAECG, signal-averaged electrocardiogram; TWA, T-wave alternans.

Mentions: A total of 5869 consecutive patients were screened in the acute phase of AMI (2–7 days after the event) in 10 European centres between August 2001 and November 2004. Of these, 1393 (23%) patients had a LVEF ≤ 0.40. After exclusions, 312 patients were included in the study. The inclusion and exclusion criteria are shown in Table 1 and a flow chart of the study design is shown in Figure 1. A consecutive series of patients with an ECG and enzyme defined AMI were screened and patients with a LVEF ≤0.40, measured 3–5 days post-AMI, were included in the study. Day 0 was the time when the AMI was diagnosed. Major reasons for exclusion from the study among the patients with a LVEF≤0.40 were refusal of the patient or the attending physician treating the patient for participation in the study (n = 380), the inability of the patient to participate in the study due to other serious illness (n = 312), planned coronary bypass graft surgery (n = 184) or death (n = 89) before the implantation of a loop-recorder and/or the risk stratification tests. The patients included in the study received an implantable ECG loop-recorder 5–21 days after AMI to document arrhythmic events and were followed-up for 24 months to document arrhythmic events. The patients had clinical visits at 3-month intervals up to 2 years after AMI. The last follow-up was planned to be at 24 months after AMI. The appropriate ethics review boards approved the protocol and the study was conducted in accordance with the Declaration of Helsinki.


Prediction of fatal or near-fatal cardiac arrhythmia events in patients with depressed left ventricular function after an acute myocardial infarction.

Huikuri HV, Raatikainen MJ, Moerch-Joergensen R, Hartikainen J, Virtanen V, Boland J, Anttonen O, Hoest N, Boersma LV, Platou ES, Messier MD, Bloch-Thomsen PE, Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction study gro - Eur. Heart J. (2009)

Study Flow Chart. *Major reasons for exclusions from the study were refusal of the patient or the attending physician treating the patient for participation in the study (n = 380), the inability of the patient to participate in the study due to other serious illness (n = 312), planned coronary bypass graft surgery (n = 184) or death (n = 89) before the implantation of a loop-recorder and/or the risk stratification tests. AMI, acute myocardial infarction; EP, electrophysiological; ILR, implantable loop-recorder; SAECG, signal-averaged electrocardiogram; TWA, T-wave alternans.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2655314&req=5

EHN537F1: Study Flow Chart. *Major reasons for exclusions from the study were refusal of the patient or the attending physician treating the patient for participation in the study (n = 380), the inability of the patient to participate in the study due to other serious illness (n = 312), planned coronary bypass graft surgery (n = 184) or death (n = 89) before the implantation of a loop-recorder and/or the risk stratification tests. AMI, acute myocardial infarction; EP, electrophysiological; ILR, implantable loop-recorder; SAECG, signal-averaged electrocardiogram; TWA, T-wave alternans.
Mentions: A total of 5869 consecutive patients were screened in the acute phase of AMI (2–7 days after the event) in 10 European centres between August 2001 and November 2004. Of these, 1393 (23%) patients had a LVEF ≤ 0.40. After exclusions, 312 patients were included in the study. The inclusion and exclusion criteria are shown in Table 1 and a flow chart of the study design is shown in Figure 1. A consecutive series of patients with an ECG and enzyme defined AMI were screened and patients with a LVEF ≤0.40, measured 3–5 days post-AMI, were included in the study. Day 0 was the time when the AMI was diagnosed. Major reasons for exclusion from the study among the patients with a LVEF≤0.40 were refusal of the patient or the attending physician treating the patient for participation in the study (n = 380), the inability of the patient to participate in the study due to other serious illness (n = 312), planned coronary bypass graft surgery (n = 184) or death (n = 89) before the implantation of a loop-recorder and/or the risk stratification tests. The patients included in the study received an implantable ECG loop-recorder 5–21 days after AMI to document arrhythmic events and were followed-up for 24 months to document arrhythmic events. The patients had clinical visits at 3-month intervals up to 2 years after AMI. The last follow-up was planned to be at 24 months after AMI. The appropriate ethics review boards approved the protocol and the study was conducted in accordance with the Declaration of Helsinki.

Bottom Line: The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms(2)) adjusted for clinical variables was 7.0 (95% CI: 2.4-20.3, P < 0.001).Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7-13.4, P = 0.003) also predicted the primary endpoint.Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, University of Oulu, PO Box 5000, Kajaanintie 50, 90014 Oulu, Finland. heikki.huikuri@oulu.fi

ABSTRACT

Aims: To determine whether risk stratification tests can predict serious arrhythmic events after acute myocardial infarction (AMI) in patients with reduced left ventricular ejection fraction (LVEF < or = 0.40).

Methods and results: A total of 5869 consecutive patients were screened in 10 European centres, and 312 patients (age 65 +/- 11 years) with a mean LVEF of 31 +/- 6% were included in the study. Heart rate variability/turbulence, ambient arrhythmias, signal-averaged electrocardiogram (SAECG), T-wave alternans, and programmed electrical stimulation (PES) were performed 6 weeks after AMI. The primary endpoint was ECG-documented ventricular fibrillation or symptomatic sustained ventricular tachycardia (VT). To document these arrhythmic events, the patients received an implantable ECG loop-recorder. There were 25 primary endpoints (8.0%) during the follow-up of 2 years. The strongest predictors of primary endpoint were measures of heart rate variability, e.g. hazard ratio (HR) for reduced very-low frequency component (<5.7 ln ms(2)) adjusted for clinical variables was 7.0 (95% CI: 2.4-20.3, P < 0.001). Induction of sustained monomorphic VT during PES (adjusted HR = 4.8, 95% CI, 1.7-13.4, P = 0.003) also predicted the primary endpoint.

Conclusion: Fatal or near-fatal arrhythmias can be predicted by many risk stratification methods, especially by heart rate variability, in patients with reduced LVEF after AMI.

Show MeSH
Related in: MedlinePlus