Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction

Schmidt, Georg; Malik, Marek; Barthel, Petra; Schneider, Raphael; Ulm, Kurt; Rolnitzky, Linda; Camm, A John; Bigger, J Thomas; Schömig, Albert

doi:10.1016/s0140-6736(98)08428-1

Cited by 674 publications

(817 citation statements)

References 25 publications

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“…HRT parameters included turbulence onset (TO) and turbulence slope (TS), which were determined according to a previously published method. 8 The TO and TS were dichotomized at predefined cut points (TO=0%, TS=2.5 ms/RR interval).…”

Section: Measurement Of Hrtmentioning

confidence: 99%

Simultaneous Assessment of T-Wave Alternans and Heart Rate Turbulence on Holter Electrocardiograms as Predictors for Serious Cardiac Events in Patients After Myocardial Infarction

Hoshida

Miwa

Miyakoshi

et al. 2013

Circ J

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Section: Measurement Of Hrtmentioning

confidence: 99%

Simultaneous Assessment of T-Wave Alternans and Heart Rate Turbulence on Holter Electrocardiograms as Predictors for Serious Cardiac Events in Patients After Myocardial Infarction

Hoshida

Miwa

Miyakoshi

et al. 2013

Circ J

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“…HRT estimates cardiac baroreceptor reflex function from the responses of NN intervals to putative transient arterial pressure reduction caused by ventricular premature contraction (VPC). The patterns of responses are classified into the following categories: normal (category 0), partially abnormal (category 1), and abnormal (category 2) (9,12,20). This measure is available only when .5 isolated VPCs suitable for the analysis are obtained from 24-hour electrocardiography.…”

Section: Hrv Analysesmentioning

confidence: 99%

“…These measures quantify various properties of heart rate dynamics, such as response patterns and self-correlations, which are caused by complex interplays between vagal and sympathetic regulations. Clinically, three measures have gained recent interest: heart rate turbulence (HRT) quantifying heart rate responses to premature beats (9), deceleration capacity (DC) estimating ability to decelerate heart rate on specific time scales (10), and fractal scaling exponents assessing fractal organization of heart rate regulation based on chaos theory (11). Several studies have indicated that these nonlinear HRV measures have greater predictive power than conventional HRV measures for mortality after myocardial infarction (MI) (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Suzuki

Aoyama

Tanaka

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Nonlinear measures of heart rate variability (HRV) have gained recent interest as powerful risk predictors in various clinical settings. This study examined whether they improve risk stratification in hemodialysis patients.Design, setting, participants, & measurements To assess heart rate turbulence, deceleration capacity, fractal scaling exponent (a 1 ), and other conventional HRV measures, 281 hemodialysis patients underwent 24-hour electrocardiography between January 2002 and May 2004 and were subsequently followed up.Results During a median 87-month follow-up, 77 patients (27%) died. Age, left ventricular ejection fraction, serum albumin, C-reactive protein, and calcium 3 phosphate independently predicted mortality. Whereas all nonlinear HRV measures predicted mortality, only decreased scaling exponent a 1 remained significant after adjusting for clinical risk factors (hazard ratio per a 0.25 decrement, 1.46; 95% confidence interval [95% CI], 1.16-1.85). The inclusion of a 1 into a prediction model composed of clinical risk factors increased the C statistic from 0.84 to 0.87 (P=0.03), with 50.8% (95% CI, 20.2-83.7) continuous net reclassification improvement for 5-year mortality. The predictive power of a 1 showed an interaction with age (P=0.02) and was particularly strong in patients aged ,70 years (n=208; hazard ratio, 1.87; 95% CI, 1.38-2.53), among whom a 1 increased the C statistic from 0.85 to 0.89 (P=0.01), with a 93.1% (95% CI, 59.3-142.0) continuous net reclassification improvement.Conclusions Scaling exponent a 1 that reflects fractal organization of short-term HRV improves risk stratification for mortality when added to the prediction model by conventional risk factors in hemodialysis patients, particularly those aged ,70 years.

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“…1 Recently, Schmidt et al 2 were able to confirm these findings in 2 large post-MI samples from the prethrombolytic and thrombolytic eras. They introduced heart rate turbulence (HRT), a surrogate marker for baroreflex response, 3 characterized by a reflex early acceleration and a subsequent deceleration of sinus rhythm after a ventricular premature beat.…”

mentioning

confidence: 83%

“…2,27 Compared with other risk stratifiers, however, the positive predictive value for adverse cardiac events is only modestly higher. 29 A considerable advantage of HRT is its applicability as a noninvasive risk marker in patients treated with ␤-blockers, representing the majority of post-MI patients.…”

Section: Validity Of Hrt As a Risk Markermentioning

confidence: 96%

Reflex Cardiac Activity in Ischemia and Reperfusion

et al. 2003

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Background-Abnormal heart rate turbulence (HRT) is associated with an increased risk of mortality in the chronic phase of myocardial infarction (MI) in the prethrombolytic and thrombolytic eras. However, the impact of direct percutaneous coronary intervention (PCI) on HRT in the acute phase of MI and its association to the epicardial infarct-related arterial flow has not been examined. Methods and Results-We investigated HRT in 126 patients undergoing direct PCI for a first MI. Turbulence onset and turbulence slope were determined before reperfusion, during the initial 2 hours after reperfusion, and during hours 6 to 24 after reperfusion. HRT significantly improved after PCI. There were no significant differences in baseline clinical characteristics between Thrombolysis in Myocardial Infarction Trial classification (TIMI) 2 (nϭ28) and TIMI 3 (nϭ98) flow. After PCI, turbulence slope increased (13.2Ϯ11 to 18.1Ϯ12 ms/beat, PϽ0.001) and turbulence onset decreased (Ϫ0.008Ϯ0.04% to Ϫ0.023Ϯ0.04%, PϽ0.01) in patients with TIMI 3 flow after PCI, whereas there were no significant alterations of turbulence slope (12.2Ϯ10 to 12.8Ϯ6.5 ms/beat) and turbulence onset (Ϫ0.009Ϯ0.05% to Ϫ0.003Ϯ0.03%) in patients with TIMI 2 flow. Conclusions-The

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Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction

Cited by 674 publications

References 25 publications

Simultaneous Assessment of T-Wave Alternans and Heart Rate Turbulence on Holter Electrocardiograms as Predictors for Serious Cardiac Events in Patients After Myocardial Infarction

Simultaneous Assessment of T-Wave Alternans and Heart Rate Turbulence on Holter Electrocardiograms as Predictors for Serious Cardiac Events in Patients After Myocardial Infarction

Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

Reflex Cardiac Activity in Ischemia and Reperfusion

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