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Prognostic value of heart rate variability after acute myocardial infarction

机译：急性心肌梗死后心率变异性的预后价值

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Background: Prognosis after acute myocardial infarction (AMI) may be infl uenced by autonomic dysfunction that can be evaluated by assessment of heart rate variability (HRV). Its predictive value resulted from studies performed prior to large scale use of reperfusion therapy. We assessed the prognostic value of HRV parameters 1 year after AMI in patients treated conventionally or by a reperfusion method in the fi rst 12 hours from onset.Material/Methods: We included 463 consecutive patients with AMI (312 M, 151 F) 60.6±13.0 years old. 211 were treated by thrombolysis or primary PTCA, the other 251 patients receiving conventional therapy. Time-domain (SDNN, rMSSD) and frequency-domain (LF, HF, total power) HRV parameters were calculated from 24-hour Holter ECG recordings 10–20 days after AMI. The primary endpoint was oneyeartotal mortality and sudden cardiac death.Results: The incidence of cardiac death was 14.7%, while that of sudden death was 4.8%. Both were higher in patients treated conventionally. Patients treated by reperfusion had higher HRV parameters reflecting both vagal and sympathetic activity (SDNN, total spectral power) as well as those expressing only vagal output (rMSSD, HF power) than conventionally treated subjects. The variables independently correlating with 1-year survival were SDNN50 msec, rMSSD20 msec, LF/HF2, non-sustained ventricular tachycardia, and left ventricular ejection fraction 40%. Conclusions: HRV parameters have prognostic value independent from left ventricular ejection fraction and spontaneous ventricular arrhythmias one year after AMI. Reduction of mortality risk by reperfusion therapy does not decrease the prognostic utility of HRV after AMI.
机译：背景：急性心肌梗死（AMI）后的预后可能受自主神经功能障碍的影响，可以通过评估心率变异性（HRV）来评估。其预测价值来自大规模使用再灌注治疗之前进行的研究。我们评估了AMI后1年内常规或通过再灌注方法在发病后12小时内HRV参数的预后价值。材料/方法：我们纳入了463例连续的AMI患者（312 M，151 F）60.6± 13.0岁。 211例接受了溶栓治疗或原发性PTCA治疗，其他251例接受了常规治疗。时域（SDNN，rMSSD）和频域（LF，HF，总功率）HRV参数是根据AMI后10至20天的24小时动态心电图记录计算得出的。主要终点为一年总死亡率和心源性猝死。结果：心源性死亡的发生率为14.7％，而猝死的发生率为4.8％。常规治疗的患者均较高。通过再灌注治疗的患者比常规治疗的受试者具有更高的HRV参数，既反映迷走神经和交感神经活动（SDNN，总频谱功率），又表达仅迷走神经输出（rMSSD，HF功率）。与1年生存率独立相关的变量为SDNN <50毫秒，rMSSD <20毫秒，LF / HF> 2，非持续性室性心动过速和左室射血分数<40％。结论：AMI后一年，HRV参数的预后价值与左室射血分数和自发性心律失常无关。通过再灌注治疗降低死亡率风险并不能降低AMI后HRV的预后效用。

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