Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction.
Background Identification of high-risk patients after acute myocardial infarction is essential for successful prophylactic therapy.
The predictive accuracy of currently used risk predictors is modest even when several factors are combined.
Thus, establishment of a new powerful method for risk prediction independent of the available stratifiers is of considerable practical value.
Methods The study investigated fluctuations of sinus-rhythm cycle length after a single ventricular premature beat recorded in Holter electrocardiograms, and characterised the fluctuations (termed heart-rate turbulence) by two numerical parameters, termed turbulence onset and slope.
The method was developed on a population of 100 patients with coronary heart disease and blindly applied to the population of the Multicentre Post-Infarction Program (MPIP ; 577 survivors of acute infarction, 75 deaths during a median follow-up of 22 months) and to the placebo population of the European Myocardial Amiodarone Trial (EMIAT ; 614 survivors of acute myocardial infarction, 87 deaths during median follow-up of 21 months).
Multivariate risk stratification was done with the new parameters and conventional risk factors.
Findings One of the new parameters (turbulence slope) was the most powerful stratifier of follow-up mortality in EMIAT and the second most powerful stratifier in MPIP : MPIP risk ratio 3.5 (95% Cl 2.2-5.5, p<0.0001), EMIAT risk ratio 2.7 (1.8-4.2, p<0.0001). (...)
Mots-clés Pascal : Infarctus, Myocarde, Facteur risque, Rythme cardiaque, Epidémiologie, Indicateur, Pronostic, Mortalité, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Infarct, Myocardium, Risk factor, Heart rate, Epidemiology, Indicator, Prognosis, Mortality, Human, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0240776
Code Inist : 002B12A03. Création : 16/11/1999.