Risk prediction in post-infarction patients with moderately reduced left ventricular ejection fraction by combined assessment of the sympathetic and vagal cardiac autonomic nervous system.

Hamm, W; Stülpnagel, L; Vdovin, N; Schmidt, G; Rizas, K D; Bauer, A

doi:10.1016/j.ijcard.2017.06.091

2017

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Document type:: Journal Article
Author(s):: Hamm, W; Stülpnagel, L; Vdovin, N; Schmidt, G; Rizas, K D; Bauer, A
Title:: Risk prediction in post-infarction patients with moderately reduced left ventricular ejection fraction by combined assessment of the sympathetic and vagal cardiac autonomic nervous system.
Abstract:: Most deaths after myocardial infarction (MI) occur in patients with normal or moderately reduced left ventricular ejection fraction (LVEF >35%). Periodic repolarization dynamics (PRD) and deceleration capacity (DC) are novel ECG-based markers related to sympathetic and vagal cardiac autonomic nervous system activity. Here, we test the combination of PRD and DC to predict risk in post-infarction patients with LVEF >35%.We included 823 survivors of acute MI with LVEF >35%, aged <=80years and in sinus rhythm. PRD and DC were obtained from 30-min ECG-recordings within the second week after index infarction and dichotomized at established cut-off values of >=5.75deg and <=2.5ms, respectively. Patients were classified as having normal (CAF 0), partly abnormal (DC or PRD abnormal; CAF 1) or abnormal cardiac autonomic function (DC and PRD abnormal; CAF 2). Primary endpoint was 5-year all-cause mortality. Within the first 5years of follow-up, 51 patients died (6.2%). PRD and DC effectively stratified patients into low-risk (CAF 0; n=562), intermediate-risk (CAF 1; n=193) and high-risk patients (CAF 2; n=68) with cumulative 5-year mortality rates of 2.9%, 9.4% and 25.2%, respectively (p<0.001). On multivariable analyses, CAF was independent from established risk factors (GRACE-score, diabetes mellitus, mean heart rate, heart rate variability). Addition of CAF significantly improved the model (increase of C-statistics from 0.732 (0.651-0.812) to 0.777 (0.703-0.850), p=0.047; continuous NRI (0.400, 95% CI 0.230-0.560, p<0.001); IDI (0.056, 95% CI 0.022-0.122, p<0.001)).CAF identifies new high-risk post-MI patients with LVEF >35% which might benefit from prophylactic strategies.
Journal title abbreviation:: Int J Cardiol
Year:: 2017
Journal volume:: 249
Pages contribution:: 1-5
Language:: eng
Fulltext / DOI:: doi:10.1016/j.ijcard.2017.06.091
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/29121716
Print-ISSN:: 0167-5273
TUM Institution:: I. Medizinische Klinik und Poliklinik (Kardiologie)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)2017