Impedance Cardiography and Heart Rate Variability for Long-Term Cardiovascular Outcome Prediction After Myocardial Infarction

Abstract

Background and Objective. The objective of our study was to evaluate the predictive power of a combined assessment of heart rate variability (HRV) and impedance cardiography (ICG) measures in order to better identify the patients at risk of serious adverse events after ST-segment elevation myocardial infarction (STEMI): all-cause or cardiac mortality (primary outcomes) and in-hospital recurrent ischemia, recurrent nonfatal MI, and need for revascularization (secondary outcomes). Material and Methods. A total of 213 study patients underwent 24-hour electrocardiogram (used for HRV analysis) and thoracic bioimpedance monitoring (used for calculation of hemodynamic measures) immediately after admission. The patients were examined on discharge and contacted after 1 and 5 years. Cox regression analysis was used to determine the predictors of selected outcomes. Results. The standard deviation of all normal-to-normal intervals (SDNN) and cardiac power output (CPO) were found to be the significant determinants of 5-year all-cause mortality (SDNN ≤100.42 ms and CPO ≤1.43 W vs. others: hazard ratio [HR], 11.1; 95% CI, 4.48–27.51; P<0.001). The standard deviation of the averages of NN intervals (SDANN) and CPO were the significant predictors of 5-year cardiac mortality (SDANN ≤85.41 ms and CPO ≤1.43 W vs. others: HR, 11.05; 95% CI, 3.75–32.56; P<0.001). None of the ICG measures was significant in predicting any secondary outcome. Conclusions. The patients with both impaired autonomic heart regulation and systolic function demonstrated by decreased heart rate variability and impedance hemodynamic measures were found to be at greater risk of all-cause and cardiac death within a 5-year period after STEMI. An integrated analysis of electrocardiogram and impedance cardiogram helps estimate patient’s risk of adverse outcomes after STEMI.

Heart Rate Variability and Risk of All-Cause Death and Cardiovascular Events in Patients With Cardiovascular Disease: A Meta-Analysis of Cohort Studies

“…After these exclusions, 31 studies remained in the present systematic review. Of these studies, three did not report the adjusted HR data (Ho et al, 1997; Kiyono, Hayano, Watanabe, Struzik, & Yamamoto, 2008; Uznańska-Loch et al, 2018); therefore, we finally included 28 eligible studies in the meta-analysis (Ablonskyte-Dudoniene et al, 2012; Al-Zaiti et al, 2014; Anastasiou-Nana et al, 2005; Aronson, Mittleman, & Burger, 2004; Batchvarov et al, 2004; Bonaduce et al, 1999; Bošković et al, 2014; Carpeggiani et al, 2005; Cebula et al, 2012; Cygankiewicz et al, 2015; Erdogan et al, 2008; Gang et al, 2011; Guzzetti et al, 2005; Harris et al, 2014; Hayano et al, 2001; Janszky et al, 2004; Kiviniemi et al, 2007; Krüger et al, 2002; La Rovere et al, 2003; Lanza et al, 1998; Y. Liu et al, 2014; P.…”

“…We defined all-cause deaths and cardiovascular events according to a previous meta-analysis (Kodama et al, 2009). In order to avoid competing risks, when an individual study provided data on both all-cause death and cause-specific death, we gave priority for data extraction to all-cause death because all-cause death is more comprehensive (Ablonskyte-Dudoniene et al, 2012; Bošković, Belada, & Knežević, 2014; Cygankiewicz et al, 2015; Lanza et al, 1998). Cardiovascular events comprised cardiac-related death, cardiac events, and sudden cardiac death.…”

Different Exercise Behaviors Influence Heart Rate Variability, Autonomic Nerve System Function and Menopausal Symptoms in Post-Menopausal Women

“…HRV was investigated using time domain analysis of the SDNN. HRV is a predictor of cardiovascular disease 15,16) , and an indicator of ventricular systolic dysfunction 17) . The results of our study show that the SDNN of post-menopausal women was 34.85 ± 23.94 ms, which was similar to the results of a previous study 18) .…”

Personality and Heart Rate Variability: Exploring Pathways from Personality to Cardiac Coherence and Health

“…High HRV is associated with reduced medical morbidity and increased longevity (Matsuoka et al, 2005), and higher cognitive functioning. Low HRV is a predictor of risk for myocardial infarct (MI), and sudden cardiac death, and all-cause mortality while high HRV is a predictor of recovery from MI (Carney et al, 2001;Ablonskytė-Dūdonienė et al, 2012). Consequently differences between people in HRV strongly predict their rates of morbidity and mortality, including both physical and psychological aspects of health (Araujo et al, 2006).…”