Evolutionary pattern and prognostic importance of heart rate variability during the early phase of acute myocardial infarction

Doulalas, A.; Flather, Marcus; Pipilis, Athanase; Campbell, Stephen; Studart, Flavio; Rizos, Ioannis; Gialafos, Ioannis H.; Toutouzas, Pavlos; Sleight, Peter

doi:10.1016/s0167-5273(00)00420-4

Cited by 22 publications

(25 citation statements)

References 34 publications

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“…Since ultra-short-term studies are performed under more controlled conditions, it is possible that on the day of admission, comparisons of intra- and interindividual HRV measurements are more confounded when derived from long recordings. In accordance with Doulalas et al [12], no significant association was found between low SDNN on admission or discharge and the incidence of non-fatal end points after discharge.…”

Section: Discussionsupporting

confidence: 90%

“…Our findings are also in accordance with those of Luria et al [23], who reported diminished variance in time domain variables within the first 24 h after STEMI (reductions in HRV were most evident as early as the first 8 h in patients with anterior MI, and 16–24 h in patients with inferior MI), and with those of a prospective study testing prognostic significance of early (≤48 h of admission for AMI) short-term (5-min) HRV measurements by Steeds et al [9], who reported a threefold increase in the risk of cardiovascular death (median follow-up of 32 months) in patients with the lowest quartile SDNN. Doulalas et al [12] tested HRV using 24-hour recordings on the day of admission and again on days 1 and 5, and reported that on the day of admission HRV was depressed compared to healthy subjects, but decreased further to reach its lowest value on day 1. In this study, 3-year mortality was significantly higher in the group with low HRV (SDNN <50 ms) on days 1 and 5 but not on the day of admission.…”

Section: Discussionmentioning

confidence: 99%

“…This can be explained by the reports that HRV starts to recover as early as 1 day after an AMI, being higher before discharge than during the first 24–48 h after admission, thus gradually losing its prognostic power [12, 13]. The latter observation is supported by a previous report [24] that tested ultra-short-term HRV (10 s) in healthy volunteers and found a mean value of 30 ± 32, very similar to our discharge SDNN, and both significantly higher that the mean admission SDNN we found.…”

Section: Discussionmentioning

confidence: 99%

“…Some investigators recommended that HRV analysis should be performed 1 week after STEMI [2, 11]. However, studies evaluating HRV during the first 48 h have also demonstrated its significant predictive value [9,12,13,14]. The predictive value of HRV has been derived almost exclusively from 24-hour Holter recordings.…”

Section: Introductionmentioning

confidence: 99%

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Ultra-Short-Term Heart Rate Variability for Early Risk Stratification following Acute ST-Elevation Myocardial Infarction

et al. 2009

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Objectives: To evaluate the prognostic significance of early ultra-short-term heart rate variability (HRV) measurement in patients admitted for ST-elevation myocardial infarction (STEMI). Methods: HRV was calculated retrospectively from the standard admission and discharge 10-second ECG of 196 consecutive patients with STEMI. Reduced HRV was defined as standard deviation of N-N intervals (SDNN) <9.5 (25th percentile). Data regarding all end points were obtained 2 years after discharge for all patients. Results: Patients’ age was 60.9 ± 13 years and 21% were female. Admission SDNN was lower than discharge SDNN (20.2 ± 18 vs. 34.2 ± 31.1, respectively; p = 0.001). Admission and discharge SDNN positively correlated with survival (r = 0.16, p = 0.03 and r = 0.15, p = 0.04, respectively), but were not predictive of other cardiovascular end points. Reduced admission SDNN was associated with increased mortality at 1 and 6 months, and 1 and 2 years after admission, while discharge SDNN was associated only with 1- and 2-year mortality. Using multivariate analysis, adjusted for potential confounders, admission SDNN <9.5 was found to be an independent risk factor for 2-year mortality (odds ratio = 2.9, 95% confidence interval = 1.12–7.56; p = 0.028). Conclusions: Reduced HRV, recorded from admission and discharge ECG, appears to be a significant and independent predictor of all-cause mortality in patients with STEMI.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultra-Short-Term Heart Rate Variability for Early Risk Stratification following Acute ST-Elevation Myocardial Infarction

et al. 2009

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“…Low HF power of the HRV spectrum is also a risk for mortality in patients, who have had myocardial infarction [10][11][12] and who have coronary artery disease 13) or congestive heart failure 14,15) .…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability in Occupational Health ―A Systematic Review

2009

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BackgroundCardiovascular disease (CVD) is the leading cause of mortality and morbidity in industrialized countries 1) . In a working population, occupational factors are believed to pose a threat to workers' cardiovascular health. Substantial research has shown that adverse physical and psychosocial work environments and working conditions, such as shift work and excessive workload, are related to CVD. To examine the acute and chronic effects of such work-related factors on the cardiovascular system, cardiac autonomic nervous system activity during work and rest has been assessed by heart rate variability (HRV).Heart rhythm is recorded by electrocardiography. The measured signal shows a series of waves that present electrical events in the four chambers and the conduction pathways within the heart. The time interval between consecutive R waves that correspond to the contraction of the ventricles is called the RR interval (RRI). HRV is a time series of RRIs that fluctuate beat by beat in healthy humans because of time-to-time changes in activities of sympathetic and parasympathetic nerves innervating to the sinus node.HRV is generated in part by periodic inputs of both respiration and blood pressure variability into the medullary cardiovascular centers 2) . These periodic modulations are clearly identified within the power spectrum of HRV as peaks at the respiratory frequency (≈ 0.25 Hz) and at the frequency of the well-known Mayer wave (0.1 Hz) in blood pressure variability 1,3) .Heart rate increases and decreases during inspiration and expiration, respectively. This is mainly caused by the physiological fact that parasympathetic output from the cardiovascular center is inhibited during inspiration 4) . Respiratory rhythm during rest is about 0.25 Hz. Therefore, exposure to occupational toxicants and hazardous environments), psychosocial workload (i.e. job stressors), and working time (i.e. shift work) had been examined and identified as having associations with low HF power. These findings may indicate that research into parasympathetic nervous system activity should be focused to protect cardiovascular health at work. We also propose the use of very low and ultralow frequency HRV components in autonomic research for workers' health.

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