Heart rate variability in the early hours of an acute myocardial infarction

Lombardi, Federico; Sandrone, Giulia; Spinnler, Maria Teresa; Torzillo, Daniela; Lavezzaro, Gian Carlo; Brusca, A; Malliani, Alberto

doi:10.1016/s0002-9149(96)00127-0

Cited by 67 publications

(44 citation statements)

References 27 publications

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“…[1][2][3] All 3 groups in the present study were examined under the same laboratory conditions to avoid confounding influences related to circadian variation, 29 alcohol, 30 visceral distension, and a large meal. 31,32 In addition, all groups were closely matched to avoid confounding factors such as age, gender, 13 race, 33 body weight, 34 and heart rate.…”

Section: Discussionmentioning

confidence: 99%

“…40 In addition, sympathetic activation and diminished vagal modulation of the heart period have been reported Ϸ3 hours after ant-AMI and inf-AMI, although they occurred to a greater extent in ant-AMI. 3 Taken together, these reports 3,39,40 indicate that any vagal overactivity and its confounding effect on sympathetic activation was shortlasting. 3 The present study was therefore conducted 2 to 4 days after AMI, with the patients in a stable condition, to avoid the volatile phase of autonomic disturbance very early after infarction and also any other confounding factors that might interfere with the sympathetic drive, such as the complications of arrhythmia and heart failure.…”

Section: Graham Et Al Sympathetic Drive and Site Of Infarctionmentioning

confidence: 93%

“…3 Taken together, these reports 3,39,40 indicate that any vagal overactivity and its confounding effect on sympathetic activation was shortlasting. 3 The present study was therefore conducted 2 to 4 days after AMI, with the patients in a stable condition, to avoid the volatile phase of autonomic disturbance very early after infarction and also any other confounding factors that might interfere with the sympathetic drive, such as the complications of arrhythmia and heart failure. Our finding in each of the 2 AMI groups of an inverse correlation between sympathetic hyperactivity and LVEF is consistent with a predominant effect of excitation of sympathetic over vagal afferents, because the former leads to efferent sympathetic activation, whereas the latter leads to sympathetic inhibition.…”

Section: Graham Et Al Sympathetic Drive and Site Of Infarctionmentioning

confidence: 93%

“…ympathetic hyperactivity has been shown to occur early after acute myocardial infarction (AMI), [1][2][3][4] although very little is known about whether its magnitude differs between anterior wall (ant-AMI) and inferior wall (inf-AMI) infarction. This information is important because it may be relevant to the prognosis after AMI and to the mechanisms of associated sympathetic activation.…”

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confidence: 99%

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Sympathetic Drive in Anterior and Inferior Uncomplicated Acute Myocardial Infarction

et al. 2004

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Background-The sympathetic activation that follows acute myocardial infarction (AMI) has been associated with increased morbidity and mortality. Because the prognosis after anterior AMI (ant-AMI) is worse than that after inferior AMI (inf-AMI), we planned to determine whether the magnitude of sympathetic hyperactivity differs between the two. Methods and Results-Thirty-nine patients with uncomplicated AMI, comprising 2 matched groups of 17 patients with ant-AMI, and 22 patients with inf-AMI were examined. Measurements were obtained 2 to 4 days after AMI and compared with 20 normal subjects (NC) who were matched in terms of age and body weight to the AMI groups. Resting muscle sympathetic nerve activity was quantified from multiunit bursts (MSNA) and from single units (s-MSNA). Both groups of AMI patients were matched with regard to hemodynamic variables, left ventricular function, and infarct size. Both groups had greater (at least PϽ0.01) sympathetic nerve activity than NC (60Ϯ4.3 bursts/100 cardiac beats and 68Ϯ4.9 impulses/100 cardiac beats), but the magnitude of sympathetic nerve hyperactivity in ant-AMI (81Ϯ4.0 bursts/100 cardiac beats and 91Ϯ4.9 impulses/100 cardiac beats) was similar (PϾ0.05) to that in inf-AMI (80Ϯ3.2 bursts/100 cardiac beats and 90Ϯ4.0 impulses/100 cardiac beats) Conclusions-Both ant-AMI and inf-AMI resulted primarily in a similar magnitude of sympathetic nerve hyperactivity.These findings suggest that the worse prognosis after ant-AMI compared with after inf-AMI would not be related primarily to the degree of sympathetic hyperactivity.

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Section: Discussionmentioning

confidence: 99%

Section: Graham Et Al Sympathetic Drive and Site Of Infarctionmentioning

confidence: 93%

Section: Graham Et Al Sympathetic Drive and Site Of Infarctionmentioning

confidence: 93%

mentioning

confidence: 99%

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Sympathetic Drive in Anterior and Inferior Uncomplicated Acute Myocardial Infarction

et al. 2004

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“…This in turn should decrease the confounding effects of other activities on comparisons of intraand interindividual results. [13][14][15][16] …”

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confidence: 99%

Prognostic significance of early short-term measurements of heart rate variability following acute myocardial infarction

Steeds

Fletcher

Smith

et al. 2004

The American Journal of Cardiology

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C ardiac autonomic control is profoundly deranged after acute myocardial infarction (AMI), with evidence of impaired vagal control and high levels of sympathetic activity. The extent of this derangement, in particular subnormal vagal activity, can be assessed by the measurement of baroreflex sensitivity and heart rate variability (HRV). There is considerable evidence to show that low levels of these markers of cardiac autonomic control are strongly and independently associated with an adverse prognosis. 1 It is currently widely believed that abnormal cardiac autonomic control after AMI is not merely a consequence of the infarct but actively and deleteriously influences the clinical course of the disease. The predictive value of HRV has been exclusively derived from a 24-hour Holter electrocardiogram, which is slow and expensive to record and analyze. 2 Isolated short-term (5-minute) recordings may be of use, but data for their predictive value are scarce and have been derived largely through the post hoc selection of suitable fragments of 24-hour recordings. 3 The aim of this study was to determine the prognostic significance of shortterm recordings of HRV soon after AMI.• • • Subjects were recruited from among patients admitted to coronary care units at 3 hospitals in the United Kingdom between 1998 and 2000. This was a substudy of a double-blind, placebo-controlled comparison of the effect of early (Յ48 hours) and late (at 5 days) angiotensin-converting enzyme (ACE) inhibition with ramipril on short-term HRV. Data presented in this report are derived from HRV recordings taken before the study drug was administered. Patients were eligible if they presented Յ48 hours of AMI in sinus rhythm. AMI was diagnosed according to criteria of the World Health Organization. 4 Patients were excluded if they had established autonomic dysfunction, had a noncardiac disease likely to influence mortality rate, had a permanent pacemaker, were already treated with ACE inhibitors, or treatment with ACE inhibitors was contraindicated. Patients who were being treated with ␤-adrenoceptor antagonists before admission were eligible for inclusion provided that there was no change to drug dose after admission but before HRV was examined. No patients began taking ␤-adrenoceptor antagonists after admission but before HRV could be examined. All patients were discharged on an ACE inhibitor. All patients gave their written informed consent before entry into the ramipril study, which was approved by the local clinical research ethics committees. The substudy, which did not involve further patient contact, received separate approval.Studies were performed Յ48 hours of admission, with subjects in the semi-supine position after a 2-hour fast and Ն30 minutes of rest in bed. Studies were performed on the admitting ward at the bedside.

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Physiological Understanding of HRV Components

Lombardi

2004

Dynamic Electrocardiography

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Heart rate variability in the early hours of an acute myocardial infarction

Cited by 67 publications

References 27 publications

Sympathetic Drive in Anterior and Inferior Uncomplicated Acute Myocardial Infarction

Sympathetic Drive in Anterior and Inferior Uncomplicated Acute Myocardial Infarction

Prognostic significance of early short-term measurements of heart rate variability following acute myocardial infarction

Physiological Understanding of HRV Components

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