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- Dokumenttyp:
- Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Validation Studies; Article
- Autor(en):
- Barthel, P; Bauer, A; Müller, A; Huster, KM; Kanters, JK; Paruchuri, V; Yang, X; Ulm, K; Malik, M; Schmidt, G
- Titel:
- Spontaneous baroreflex sensitivity: prospective validation trial of a novel technique in survivors of acute myocardial infarction.
- Abstract:
- Low baroreflex sensitivity (BRS) indicates poor prognosis after acute myocardial infarction. Noninvasive BRS assessment is complicated by nonstationarities and noise in electrocardiogram and pressure signals. Phase-rectified signal averaging is a novel signal processing technology overcoming these problems.To prospectively validate a BRS measure (baroreflex sensitivity assessed by means of phase-rectified signal averaging [BRS(PRSA)]) based on this technology.Nine hundred forty-one consecutive acute myocardial infarction survivors aged 80 years or younger in sinus rhythm were prospectively enrolled at 2 German university hospitals. All patients underwent 30-minute recordings of electrocardiogram and arterial blood pressures (Portapres; TNO-TPD Biomedical Instrumentation, Amsterdam, Netherlands) within the first 2 weeks after myocardial infarction. BRS(PRSA) was prospectively dichotomized at 1.58 ms/mm Hg. Primary end point was all-cause mortality at 5 years. Multivariable analyses included Global Registry of Acute Coronary Events score (dichotomized at >>=120), sex, BRS(PRSA), left ventricular ejection fraction (dichotomized at <=35%), and diabetes mellitus. BRS(PRSA) was compared with 3 standard noninvasive BRS measures, that is, the sequence method, the transfer function method, and the correlation method.During follow-up, 72 patients (7.7%) died. BRS(PRSA) stratified the study population into a high-risk group of 405 patients (<<=1.58 ms/mm Hg) with an estimated 5-year mortality of 14.2% and a low-risk group of 536 patients (>1.58 ms/mm Hg) with a 5-year mortality of 2.8% (P <.0001). On multivariable analysis, BRS(PRSA) <= 1.58 ms/mm Hg was associated with a hazard ratio of 3.1 (confidence interval 1.7-5.6; P = .001). Predictive power of BRS(PRSA) <= 1.58 ms/mm Hg was particularly strong in patients with a Global Registry of Acute Coronary Events score of >=120 or with a left ventricular ejection fraction of <=35%.BRS(PRSA) is a powerful and independent predictor of mortality in postinfarction patients especially when assessed in patients with a Global Registry of Acute Coronary Events score of >=120 or a left ventricular ejection fraction of <<=35%.
- Zeitschriftentitel:
- Heart Rhythm
- Jahr:
- 2012
- Band / Volume:
- 9
- Heft / Issue:
- 8
- Seitenangaben Beitrag:
- 1288-94
- Sprache:
- eng
- Volltext / DOI:
- doi:10.1016/j.hrthm.2012.04.017
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/22516186
- Print-ISSN:
- 1547-5271
- TUM Einrichtung:
- I. Medizinische Klinik und Poliklinik (Kardiologie); Institut für Medizinische Statistik und Epidemiologie
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