Improved Stratification of Autonomic Regulation for risk prediction in post-infarction patients with preserved left ventricular function (ISAR-Risk).

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

doi:10.1093/eurheartj/ehn540

2009

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Dokumenttyp:: Evaluation Studies; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Article
Autor(en):: 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
Titel:: 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%.
Zeitschriftentitel:: Eur Heart J
Jahr:: 2009
Band / Volume:: 30
Heft / Issue:: 5
Seitenangaben Beitrag:: 576-83
Sprache:: eng
Volltext / DOI:: doi:10.1093/eurheartj/ehn540
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/19109245
Print-ISSN:: 0195-668X
TUM Einrichtung:: I. Medizinische Klinik und Poliklinik (Kardiologie); Institut für Medizinische Statistik und Epidemiologie
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