Risk prediction in post-infarction patients with moderately reduced left ventricular ejection fraction by combined assessment of the sympathetic and vagal cardiac autonomic nervous system
| Autor: | Georg Schmidt, Wolfgang Hamm, Nikolay Vdovin, Lukas von Stülpnagel, K. D. Rizas, Axel Bauer |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Sympathetic Nervous System Myocardial Infarction Infarction 030204 cardiovascular system & hematology Autonomic Nervous System Sudden cardiac death Electrocardiography Ventricular Dysfunction Left 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Risk Factors Internal medicine Humans Medicine Repolarization Sinus rhythm 030212 general & internal medicine Myocardial infarction Aged Ejection fraction business.industry Mortality rate Stroke Volume Vagus Nerve Middle Aged medicine.disease Autonomic nervous system Cardiology Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | International Journal of Cardiology. 249:1-5 |
| ISSN: | 0167-5273 |
| Popis: | Aim Most deaths after myocardial infarction (MI) occur in patients with normal or moderately reduced left ventricular ejection fraction (LVEF >35%). Periodic repolarization dynamics (PRD) and deceleration capacity (DC) are novel ECG-based markers related to sympathetic and vagal cardiac autonomic nervous system activity. Here, we test the combination of PRD and DC to predict risk in post-infarction patients with LVEF >35%. Methods and results We included 823 survivors of acute MI with LVEF >35%, aged ≤80years and in sinus rhythm. PRD and DC were obtained from 30-min ECG-recordings within the second week after index infarction and dichotomized at established cut-off values of ≥5.75deg 2 and ≤2.5ms, respectively. Patients were classified as having normal (CAF 0), partly abnormal (DC or PRD abnormal; CAF 1) or abnormal cardiac autonomic function (DC and PRD abnormal; CAF 2). Primary endpoint was 5-year all-cause mortality. Within the first 5years of follow-up, 51 patients died (6.2%). PRD and DC effectively stratified patients into low-risk (CAF 0; n=562), intermediate-risk (CAF 1; n=193) and high-risk patients (CAF 2; n=68) with cumulative 5-year mortality rates of 2.9%, 9.4% and 25.2%, respectively (p Conclusion CAF identifies new high-risk post-MI patients with LVEF >35% which might benefit from prophylactic strategies. |
| Databáze: | OpenAIRE |
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