Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction
Key result
Low heart-rate variability (<70 ms) and baroreflex sensitivity (<3.0 ms/mmHg) independently predicted post-infarction cardiac mortality, increasing 2-year mortality to 17% when both were low.
Why the study?
Do low heart-rate variability and baroreflex sensitivity predict cardiac mortality in patients with recent myocardial infarction?
Population
1284 patients with a recent (<28 days) myocardial infarction
Comparison
Measurement of heart-rate variability via 24 h… vs Patients with preserved heart-rate variability…
Design
Cohort
Follow-up
21 (SD 8) months
Authors
Discussion
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Member takes
Implication
May refine post-MI risk stratification beyond LVEF; leaves open prospective validation before clinical use.
Key Points
- Assess the prognostic value of heart-rate variability and baroreflex sensitivity for cardiac mortality after myocardial infarction.
- Multicenter international prospective study
- Enrolled 1284 patients with recent myocardial infarction
- Used 24-hour Holter recording for heart-rate variability and phenylephrine for baroreflex sensitivity measurement.
- Observed 44 cardiac deaths and 5 non-fatal cardiac arrests during follow-up.
- Low heart-rate variability and baroreflex sensitivity both significantly increased the risk of cardiac mortality.
- Two-year mortality was 17% with low values of both metrics compared to just 2% with preserved values.
Structured PICO
Do low heart-rate variability and baroreflex sensitivity predict cardiac mortality in patients with recent myocardial infarction?
P
Population
1284 patients with a recent (<28 days) myocardial infarction
I
Intervention
Measurement of heart-rate variability (SDNN) via 24 h Holter recording and baroreflex sensitivity (BRS) via rate-pressure response to intravenous phenylephrine
C
Comparator
Patients with preserved heart-rate variability (SDNN >105 ms) and BRS (>6.1 ms per mm Hg)
O
Outcome
Cardiac mortality (cardiac deaths and non-fatal cardiac arrests) during 21 (SD 8) months of follow-uphard clinical
Low heart-rate variability and baroreflex sensitivity are independent predictors of cardiac mortality after recent myocardial infarction, adding prognostic value beyond LVEF and ventricular arrhythmias.
Cite This Study
Rovere et al. (1998) studied this question. Low heart-rate variability (<70 ms) and baroreflex sensitivity (<3.0 ms/mmHg) independently predicted post-infarction cardiac mortality, increasing 2-year mortality to 17% when both were low.