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- Document type:
- Journal Article; Article
- Author(s):
- Barthel, P; Schneider, R; Bauer, A; Ulm, K; Schmitt, C; Schömig, A; Schmidt, G
- Title:
- Risk stratification after acute myocardial infarction by heart rate turbulence.
- Abstract:
- BACKGROUND: Retrospective postinfarction studies revealed that decreased heart rate turbulence (HRT) indicates increased risk for subsequent death. This is the first prospective study to validate HRT in a large cohort of the reperfusion era. METHODS AND RESULTS: One thousand four hundred fifty-five survivors of an acute myocardial infarction (age <76 years) in sinus rhythm were enrolled. HRT onset (TO) and slope (TS) were calculated from Holter records. Patients were classified into the following HRT categories: category 0 if both TO and TS were normal, category 1 if either TO or TS was abnormal, or category 2 if both TO and TS were abnormal. The primary end point was all-cause mortality. During a follow-up of 22 months, 70 patients died. Multivariately, HRT category 2 was the strongest predictor of death (hazard ratio, 5.9; 95% CI, 2.9 to 12.2), followed by left ventricular ejection fraction (LVEF) < or =30% (4.5; 2.6 to 7.8), diabetes mellitus (2.5; 1.6 to 4.1), age > or =65 years (2.4; 1.5 to 3.9), and HRT category 1 (2.4; 1.2 to 4.9). LVEF < or =30% had a sensitivity of 27% at a positive predictive accuracy level of 23%. The combined criteria of LVEF < or =30%, HRT category 2 or LVEF >30%, age > or =65 years, diabetes mellitus, and HRT category 2 had a sensitivity of 24% at a positive predictive accuracy level of 37%. The combined criteria of LVEF < or =30% or LVEF >30%, age > or =65 years, diabetes mellitus, and HRT category 1 or 2 had a sensitivity of 44% at a positive predictive accuracy level of 23%. CONCLUSIONS: HRT is a strong predictor of subsequent death in postinfarction patients of the reperfusion era.
- Journal title abbreviation:
- Circulation
- Year:
- 2003
- Journal volume:
- 108
- Journal issue:
- 10
- Pages contribution:
- 1221-6
- Language:
- eng
- Fulltext / DOI:
- doi:10.1161/01.CIR.0000088783.34082.89
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/12939209
- Print-ISSN:
- 0009-7322
- TUM Institution:
- I. Medizinische Klinik und Poliklinik (Kardiologie); Institut für Medizinische Statistik und Epidemiologie
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