Predictive power of increased heart rate versus depressed left ventricular ejection fraction and heart rate variability for risk stratification after myocardial infarction

Abstract

Predischarge 24-h mean heart rate is a strong predictor of mortality after myocardial infarction that can compete with left ventricular ejection fraction and heart rate variability.

Sympathetic Overdrive and Cardiovascular Risk in the Metabolic Syndrome

“…This has been shown, for example, in patients with congestive heart failure, in which indirect and direct markers of systemic and regional sympathetic drive (venous plasma norepinephrine, heart rate variability, heart rate spectral power, cardiac and renal norepinephrine spillover) have been documented to bear a close and direct relationship with cardiovascular mortality, disease progression and arrhythmic events, including sudden death (46)(47)(48)(49)(50)(51). Similar conclusions have been drawn by assessing the prognostic values of plasma norepinephrine or heart rate variability in the post-stroke phase following an acute myocardial infarction or in patients with vasospastic angina (52)(53)(54)(55). Finally, dysfunction in sympathetic cardiovascular control has also been shown to have prognostic value in non-cardiovascular diseases such as diabetes mellitus and renal failure (56,57), thereby documenting the clinical relevance of the neuroadrenergic overdrive in a broad spectrum of pathological states.…”

Sleep Apnea and Cardiovascular Disease

“…73 In patients with cardiovascular disease, reduced heart rate variability is associated with poorer outcomes. [75][76][77] The Framingham Heart Study has implicated lower heart rate variability as a precursor to the development of future hypertension, 78 and increased BP variability has been implicated in increased risk of end-organ damage in patients with hypertension. 79 …”

Relation of Ejection Fraction and Inducible Ventricular Tachycardia to Mode of Death in Patients With Coronary Artery Disease

“…Further evidence of the contribution of patients with ejection fraction Ͼ30% to sudden death events in survivors of acute infarction is provided by an analysis by Copie et al 27 These authors divided 579 survivors of acute infarction by quartiles of ejection fraction: Ն58%, 49% to 58%, 36% to 49%, and Յ36%. Although 2-year all-cause mortality was higher in the quartile whose ejection fraction was Յ36% than in the quartile with ejection fraction of 36% to 49% (19.4% versus 9.0%), the incidence of sudden death was the same for both quartiles (6.3% and 6.2%, respectively).…”