Heart rate turbulence-based predictors of fatal and nonfatal cardiac arrest (The autonomic tone and reflexes after myocardial infarction substudy)

Ghuran, Azad; Reid, Fiona; Rovere, Maria Teresa La; Schmidt, Georg; Bigger, J. Thomas; Camm, A. John; Schwartz, Peter J.; Malík, Marek

doi:10.1016/s0002-9149(01)02198-1

Cited by 206 publications

(195 citation statements)

References 14 publications

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“…1,27 Consistent with previous studies, we were able to reproduce a weak correlation between HRT and HRV. In contrast to HRT, there were no significant differences in HRV after PCI in patients with TIMI 2 and 3 flow, suggesting that successful reperfusion mainly improves reflex vagal tone.…”

Section: Heart Rate Variability and Hrt In Acute MIsupporting

confidence: 90%

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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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Section: Heart Rate Variability and Hrt In Acute MIsupporting

confidence: 90%

“…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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“…Likewise, it is not true that our ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) outcome variable was different from previous investigations; the same outcome (cardiac mortalityϩresuscitated cardiac arrest) was prospectively defined in the original study and subsequently used consistently, including that in the HRT substudy. 4 Although we can understand the enthusiasm of Watanabe and Guzik for HRT, they will surely agree that different risk factors have no conflict of interest. Our goal is in improving the risk assessment, not in shielding one risk factor.…”

Section: Responsementioning

confidence: 99%

“…5 In contrast, the hazard ratio of HRT in multivariate analysis improved from 3.2 in the EMIAT placebo arm population, in whom only 60% of the patients had received thrombolysis, 2 to 5.9 in the modern population. 4 There were also some methodological differences in the analysis of HRT between the PLF article and previous HRT publications. For example, combining turbulence slope and turbulence onset usually provides the best predictive ability.…”

Section: To the Editormentioning

confidence: 99%

“…Their study is noteworthy because in previous comparisons of measures of HRT and heart rate variability in large studies, HRT has consistently outperformed heart rate variability. [2][3][4] We would like to point out that the prognostic ability of risk factors is changing significantly with declining mortality from acute ischemic events as a result of improved treatment protocols, and that the superiority of PLF may not hold true in a contemporary population. For example, we found that late potentials lost their predictive ability entirely in a modern population of patients, 90% of whom received percutaneous coronary intervention and 84% received statins.…”

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confidence: 99%

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Letter Regarding Article by Wichterle et al, “Prevalent Low-Frequency Oscillation of Heart Rate: Novel Predictor of Mortality After Myocardial Infarction”

Watanabe

Guzik

2005

Circulation

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et al recently presented in this journal a novel parameter of heart rate variability called prevalent low-frequency oscillation of heart rate (PLF). 1 Using 2 groups of postinfarction patients derived from the EMIAT (European Myocardial Infarction Amiodarone Trial) and ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) studies, they specifically compared and showed a predictive value for PLF that was stronger than that for heart rate turbulence (HRT) parameters using univariate analysis. They further showed that with Cox's multivariate regression model, the relative risk for PLF remained high (4.6 and 3.6 in EMIAT and ATRAMI, respectively), whereas HRT parameters turbulence slope and turbulence onset lost their independence. Their study is noteworthy because in previous comparisons of measures of HRT and heart rate variability in large studies, HRT has consistently outperformed heart rate variability. [2][3][4] We would like to point out that the prognostic ability of risk factors is changing significantly with declining mortality from acute ischemic events as a result of improved treatment protocols, and that the superiority of PLF may not hold true in a contemporary population. For example, we found that late potentials lost their predictive ability entirely in a modern population of patients, 90% of whom received percutaneous coronary intervention and 84% received statins. 5 In contrast, the hazard ratio of HRT in multivariate analysis improved from 3.2 in the EMIAT placebo arm population, in whom only 60% of the patients had received thrombolysis, 2 to 5.9 in the modern population. 4 There were also some methodological differences in the analysis of HRT between the PLF article and previous HRT publications. For example, combining turbulence slope and turbulence onset usually provides the best predictive ability. 2,3 Wichterle et al did not show how the combined HRT parameters performed against PLF. The end point for the ATRAMI population was cardiac mortality or resuscitated cardiac arrest, in contrast to all-cause mortality, which is commonly used in HRT studies. Finally, it is unclear why Wichterle et al used different criteria for admissible Holter recordings for their 2 patient populations based on the number of ventricular premature complexes-a minimum of 1 in the ATRAMI versus 5 for the EMIAT. It is generally accepted that a larger number of ventricular premature complexes for HRT calculation produces more stable values. Mari

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2004

Current Indications for the Implantable Cardioverter Defibrillator

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Heart rate turbulence-based predictors of fatal and nonfatal cardiac arrest (The autonomic tone and reflexes after myocardial infarction substudy)

Cited by 206 publications

References 14 publications

Reflex Cardiac Activity in Ischemia and Reperfusion

Reflex Cardiac Activity in Ischemia and Reperfusion

Letter Regarding Article by Wichterle et al, “Prevalent Low-Frequency Oscillation of Heart Rate: Novel Predictor of Mortality After Myocardial Infarction”

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