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Document type:
journal article 
Author(s):
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 
Title:
Improved Stratification of Autonomic Regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-Risk). 
Abstract:
AIMS: To investigate the combination of heart rate turbulence (HRT) and deceleration capacity (DC) as risk predictors in post-infarction patients with left ventricular ejection fraction (LVEF)> 30%. METHODS AND RESULTS: We enrolled 2343 consecutive survivors of acute myocardial infarction (MI) (<76 years) in sinus rhythm. HRT and DC were obtained from 24 h Holter recordings. Patients with both abnormal HRT (slope< or = 2.5 ms/RR and onset> or = 0%) and abnormal DC (< or =4.5 ms) were considered suffering from severe autonomic failure (SAF) and prospectively classified as high risk. Primary and secondary endpoints were all-cause, cardiac, and sudden cardiac mortality within the first 5 years of follow-up. During follow-up, 181 patients died; 39 deaths occurred in 120 patients with LVEF< or = 30%, and 142 in 2223 patients with LVEF>30% (cumulative 5-year mortality rates of 37.9% and 7.8%, respectively). Among patients with LVEF> 30%, SAF identified another high-risk group of 117 patients with 37 deaths (cumulative 5-year mortality rates of 38.6% and 6.1%, respectively). Merging both high-risk groups (i.e. LVEF< or = 30% and/or SAF) doubled the sensitivity of mortality prediction compared with LVEF< or = 30% alone (21.1% vs. 42.1%, P< 0.001) while preserving 5-year mortality rate (38.2%). CONCLUSION: In post-MI patients with LVEF>30%, SAF identifies a high-risk group equivalent in size and mortality risk to patients with LVEF< or = 30%. 
Journal title abbreviation:
Eur Heart J 
Year:
2009 
Journal volume:
30 
Journal issue:
Pages contribution:
576-83 
Language:
eng 
Print-ISSN:
0195-668X 
TUM Institution:
I. Medizinische Klinik und Poliklinik; r Medizinische Statistik und Epidemiologie