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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.

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Related in: MedlinePlus

Kaplan–Meier estimate of the time from MI to primary endpoint, stratified by inducible sustained monomorphic ventricular tachycardia (MMVT) (panel A) and by reduced very-low frequency spectral component (VLF) of heart rate variability (panel B).
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EHN537F4: Kaplan–Meier estimate of the time from MI to primary endpoint, stratified by inducible sustained monomorphic ventricular tachycardia (MMVT) (panel A) and by reduced very-low frequency spectral component (VLF) of heart rate variability (panel B).

Mentions: Table 4 shows the sensitivity, specificity, and predictive values of significant predictors of the primary endpoint. These values illustrate the relatively high accuracy of some heart rate variability indexes, especially the very-low frequency spectral component, as well as inducibility of sustained monomorphic VT in predicting the primary endpoint. The Kaplan–Meier representation of time to primary endpoint is shown in Figure 4, stratified by inducibility of sustained monomorphic VT or by reduced very-low frequency spectral component of heart rate variability.


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)

Kaplan–Meier estimate of the time from MI to primary endpoint, stratified by inducible sustained monomorphic ventricular tachycardia (MMVT) (panel A) and by reduced very-low frequency spectral component (VLF) of heart rate variability (panel B).
© Copyright Policy
Related In: Results  -  Collection

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

EHN537F4: Kaplan–Meier estimate of the time from MI to primary endpoint, stratified by inducible sustained monomorphic ventricular tachycardia (MMVT) (panel A) and by reduced very-low frequency spectral component (VLF) of heart rate variability (panel B).
Mentions: Table 4 shows the sensitivity, specificity, and predictive values of significant predictors of the primary endpoint. These values illustrate the relatively high accuracy of some heart rate variability indexes, especially the very-low frequency spectral component, as well as inducibility of sustained monomorphic VT in predicting the primary endpoint. The Kaplan–Meier representation of time to primary endpoint is shown in Figure 4, stratified by inducibility of sustained monomorphic VT or by reduced very-low frequency spectral component of heart rate variability.

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