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(Circulation. 2001;103:2072.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Baroreflex Sensitivity and Heart Rate Variability in the Identification of Patients at Risk for Life-Threatening Arrhythmias
Implications for Clinical Trials
From the Centro Medico di Montescano, Fondazione "Salvatore Maugeri" IRCCS, Montescano, Pavia, Italy (M.T.L.R., G.D.P., A.M.); the Klinikum der Johann Wolfgang Goethe-Universitat, Medizinische Klinik IV, Kardiologie und Nephrologie, Frankfurt, Germany (S.H.H.); the Department of Internal Medicine, Section of Cardiology, University of Arizona Health Sciences Center, Tucson, Ariz (F.I.M.); the Division of Cardiology, Policlinico di Monza, Monza, Italy (A.M.); the Third Division of Internal Medicine, Kyoto University Hospital, Kyoto, Japan (R.N.); the Department of Medicine, Cardiology Division, Columbia University, College of Physicians and Surgeons, New York, NY (J.T.B.); the Department of Cardiological Sciences, St George’s Hospital Medical School, London, UK (A.J.C.); and the Department of Cardiology, University of Pavia and Policlinico S. Matteo Istituto di Ricovero e Cura a Carattere Scientifico, Pavia, Italy (P.J.S.).
Background—The need for accurate risk stratification is heightened by the expanding indications for the implantable cardioverter defibrillator. The Multicenter Automatic Defibrillator Implantation Trial (MADIT) focused interest on patients with both depressed left ventricular ejection fraction (LVEF) and the presence of nonsustained ventricular tachycardia (NSVT). Meanwhile, the prospective study Autonomic Tone and Reflexes After Myocardial Infarction (ATRAMI) demonstrated that markers of reduced vagal activity, such as depressed baroreflex sensitivity (BRS) and heart rate variability (HRV), are strong predictors of cardiac mortality after myocardial infarction.
Methods and Results—We analyzed 1071 ATRAMI patients after myocardial infarction who had data on LVEF, 24-hour ECG recording, and BRS. During follow-up (21±8 months), 43 patients experienced cardiac death, 5 patients had episodes of sustained VT, and 30 patients experienced sudden death and/or sustained VT. NSVT, depressed BRS, or HRV were all significantly and independently associated with increased mortality. The combination of all 3 risk factors increased the risk of death by 22x. Among patients with LVEF<35%, despite the absence of NSVT, depressed BRS predicted higher mortality (18% versus 4.6%, P=0.01). This is a clinically important finding because this group constitutes 25% of all patients with depressed LVEF. For both cardiac and arrhythmic mortality, the sensitivity of low BRS was higher than that of NSVT and HRV.
Conclusions—BRS and HRV contribute importantly and additionally to risk stratification. Particularly when LVEF is depressed, the analysis of BRS identifies a large number of patients at high risk for cardiac and arrhythmic mortality who might benefit from implantable cardioverter defibrillator therapy without disproportionately increasing the number of false-positives.
Key Words: nervous system, autonomic • baroreceptors • heart rate • myocardial infarction • arrhythmia
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|
|
|
|
|
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|
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|
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|
|
|
|
|
|
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|
|
|
|
 |
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|
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|
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|
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|
|
|
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|
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|
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|
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|
|
|
|
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|
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|
|
|
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|
|
|
|
 |
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
 Z. Goldberger and R. Lampert Implantable Cardioverter-Defibrillators: Expanding Indications and Technologies JAMA, February 15, 2006; 295(7): 809 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H C Routledge, S Manney, R M Harrison, J G Ayres, and J N Townend Effect of inhaled sulphur dioxide and carbon particles on heart rate variability and markers of inflammation and coagulation in human subjects Heart, February 1, 2006; 92(2): 220 - 227. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
J. R. Padley, D. H. Overstreet, P. M. Pilowsky, and A. K. Goodchild Impaired cardiac and sympathetic autonomic control in rats differing in acetylcholine receptor sensitivity Am J Physiol Heart Circ Physiol, November 1, 2005; 289(5): H1985 - H1992. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Falcone, M. P. Buzzi, C. Klersy, and P. J. Schwartz Rapid Heart Rate Increase at Onset of Exercise Predicts Adverse Cardiac Events in Patients With Coronary Artery Disease Circulation, September 27, 2005; 112(13): 1959 - 1964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Gehi, D. Haas, and V. Fuster Primary Prophylaxis With the Implantable Cardioverter-Defibrillator: The Need for Improved Risk Stratification JAMA, August 24, 2005; 294(8): 958 - 960. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kubo, J. D. Parker, E. R. Azevedo, D. J. Atchison, G. E. Newton, P. Picton, and J. S. Floras Vagal heart rate responses to chronic beta-blockade in human heart failure relate to cardiac norepinephrine spillover Eur J Heart Fail, August 1, 2005; 7(5): 878 - 881. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Buxton, A. J. Moss, A. E. Buxton, and A. J. Moss Should everyone with an ejection fraction less than or equal to 30% receive an implantable cardioverter-defibrillator? Circulation, May 17, 2005; 111(19): 2537 - 2549. [Full Text] [PDF]
|
|
|
|
 |
|
 X. Jouven, J.-P. Empana, P. J. Schwartz, M. Desnos, D. Courbon, and P. Ducimetiere Heart-Rate Profile during Exercise as a Predictor of Sudden Death N. Engl. J. Med., May 12, 2005; 352(19): 1951 - 1958. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. E. Hunt and W. B. Farquhar Nonlinearities and asymmetries of the human cardiovagal baroreflex Am J Physiol Regulatory Integrative Comp Physiol, May 1, 2005; 288(5): R1339 - R1346. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Carney, K. E. Freedland, and R. C. Veith Depression, the Autonomic Nervous System, and Coronary Heart Disease Psychosom Med, May 1, 2005; 67(Supplement_1): S29 - S33. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. P Sloan, M.-H. Huang, S. Sidney, K. Liu, O D. Williams, and T. Seeman Socioeconomic status and health: is parasympathetic nervous system activity an intervening mechanism? Int. J. Epidemiol., April 1, 2005; 34(2): 309 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
 L. MONTEBUGNOLI, D. SERVIDIO, R. A. MIATON, and C. PRATI Heart rate variability: A sensitive parameter for detecting abnormal cardiocirculatory changes during a stressful dental procedure J Am Dent Assoc, December 1, 2004; 135(12): 1718 - 1723. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M P Frenneaux Autonomic changes in patients with heart failure and in post-myocardial infarction patients Heart, November 1, 2004; 90(11): 1248 - 1255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Adamson, J. Suarez, E. Ellis, T. Kanaly, and E. Vanoli Ephedrine increases ventricular arrhythmias in conscious dogs after myocardial infarction J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1675 - 1678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Adamson, A. L. Smith, W. T. Abraham, K. J. Kleckner, R. W. Stadler, A. Shih, M. M. Rhodes, and on behalf of the InSync III Model 8042 and Attain Continuous Autonomic Assessment in Patients With Symptomatic Heart Failure: Prognostic Value of Heart Rate Variability Measured by an Implanted Cardiac Resynchronization Device Circulation, October 19, 2004; 110(16): 2389 - 2394. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G Katritsis and A.J. Camm Nonsustained ventricular tachycardia: where do we stand? Eur. Heart J., July 1, 2004; 25(13): 1093 - 1099. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Chowdhary, A. M. Marsh, J. H. Coote, and J. N. Townend Nitric Oxide and Cardiac Muscarinic Control in Humans Hypertension, May 1, 2004; 43(5): 1023 - 1028. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Camm, C. M. Pratt, P. J. Schwartz, H. R. Al-Khalidi, M. J. Spyt, M. J. Holroyde, R. Karam, E. H. Sonnenblick, J. M.G. Brum, and on Behalf of the AzimiLide post Infarct surVival E Mortality in Patients After a Recent Myocardial Infarction: A Randomized, Placebo-Controlled Trial of Azimilide Using Heart Rate Variability for Risk Stratification Circulation, March 2, 2004; 109(8): 990 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Bauernschmitt, H. Malberg, N. Wessel, B. Kopp, E.U. Schirmbeck, and R. Lange Impairment of cardiovascular autonomic control in patients early after cardiac surgery Eur. J. Cardiothorac. Surg., March 1, 2004; 25(3): 320 - 326. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Nightingale, M. Schmitt, M. P. Frenneaux, G. Piccirillo, M. Nocco, A. Moise, M. Lionetti, C. Naso, and S. D. C. V. Marigliano Letter: Vitamin C in Heart Failure: Hype or Hope? Hypertension, February 1, 2004; e6(2): . [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Masters, J. S. Stevenson, and S. F. Schaal The Association Between Moderate Drinking and Heart Rate Variability in Healthy Community-Dwelling Older Women Biol Res Nurs, January 1, 2004; 5(3): 222 - 233. [Abstract] [PDF]
|
|
|
|
|
|
D. P. Vivekananthan, E. H. Blackstone, C. E. Pothier, and M. S. Lauer Heart rate recovery after exercise is apredictor of mortality, independent of the angiographic severity of coronary disease J. Am. Coll. Cardiol., September 3, 2003; 42(5): 831 - 838. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. V. Huikuri, J. M. Tapanainen, K. Lindgren, P. Raatikainen, T. H. Makikallio, K. E. Juhani Airaksinen, and R. J. Myerburg Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era J. Am. Coll. Cardiol., August 20, 2003; 42(4): 652 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Halamek, T. Kara, P. Jurak, M. Soucek, D. P. Francis, L. C. Davies, W. K. Shen, A. J.S. Coats, M. Novak, Z. Novakova, et al. Variability of Phase Shift Between Blood Pressure and Heart Rate Fluctuations: A Marker of Short-Term Circulation Control Circulation, July 22, 2003; 108(3): 292 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. V. Huikuri, T. H. Makikallio, M. J. P. Raatikainen, J. Perkiomaki, A. Castellanos, and R. J. Myerburg Prediction of Sudden Cardiac Death: Appraisal of the Studies and Methods Assessing the Risk of Sudden Arrhythmic Death Circulation, July 8, 2003; 108(1): 110 - 115. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Loimaala, H. V. Huikuri, T. Koobi, M. Rinne, A. Nenonen, and I. Vuori Exercise Training Improves Baroreflex Sensitivity in Type 2 Diabetes Diabetes, July 1, 2003; 52(7): 1837 - 1842. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Piccirillo, M. Nocco, A. Moise, M. Lionetti, C. Naso, S. di Carlo, and V. Marigliano Influence of Vitamin C on Baroreflex Sensitivity in Chronic Heart Failure Hypertension, June 1, 2003; 41(6): 1240 - 1245. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Bradley and J. S. Floras Sleep Apnea and Heart Failure: Part I: Obstructive Sleep Apnea Circulation, April 1, 2003; 107(12): 1671 - 1678. [Full Text] [PDF]
|
|
|
|
|
|
S. H. Hohnloser and B. J. Gersh Changing Late Prognosis of Acute Myocardial Infarction: Impact on Management of Ventricular Arrhythmias in the Era of Reperfusion and the Implantable Cardioverter-Defibrillator Circulation, February 25, 2003; 107(7): 941 - 946. [Full Text] [PDF]
|
|
|
|
|
|
P. A. Lanfranchi and V. K Somers Arterial baroreflex function and cardiovascular variability: interactions and implications Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2002; 283(4): R815 - R826. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. La Rovere, C. Bersano, M. Gnemmi, G. Specchia, and P. J. Schwartz Exercise-Induced Increase in Baroreflex Sensitivity Predicts Improved Prognosis After Myocardial Infarction Circulation, August 20, 2002; 106(8): 945 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. P Francis, K. Willson, P. Georgiadou, R. Wensel, L C. Davies, A. Coats, and M. Piepoli Physiological basis of fractal complexity properties of heart rate variability in man J. Physiol., July 15, 2002; 542(2): 619 - 629. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Pietila, K. Malminiemi, R. Vesalainen, T. Jartti, M. Teras, K. Nagren, P. Lehikoinen, and L.-M. Voipio-Pulkki Exercise Training in Chronic Heart Failure: Beneficial Effects on Cardiac 11C-Hydroxyephedrine PET, Autonomic Nervous Control, and Ventricular Repolarization J. Nucl. Med., June 1, 2002; 43(6): 773 - 779. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kaushal and J. A. Taylor Inter-relations among declines in arterial distensibility, baroreflex function and respiratory sinus arrhythmia J. Am. Coll. Cardiol., May 1, 2002; 39(9): 1524 - 1530. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Makikallio, H. V. Huikuri, M. T. La Rovere, G. D. Pinna, S. H. Hohnloser, F. I. Marcus, A. Mortara, R. Nohara, J. T. Bigger Jr, A. J. Camm, et al. Risks in Risk Stratification: What Is Relevant in Practice? * Response Circulation, March 26, 2002; 105 (12): e69 - e70. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Zoccali, F. Mallamaci, and G. Tripepi Nocturnal Hypoxemia Predicts Incident Cardiovascular Complications in Dialysis Patients J. Am. Soc. Nephrol., March 1, 2002; 13(3): 729 - 733. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. Curtis and J. H. O'Keefe Jr Autonomic Tone as a Cardiovascular Risk Factor: The Dangers of Chronic Fight or Flight Mayo Clin. Proc., January 1, 2002; 77(1): 45 - 54. [Abstract] [PDF]
|
|
|
|
|
|
M. J. Eisenberg Risk stratification for arrhythmic events: are the bangs worth the bucks? J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1912 - 1915. [Full Text] [PDF]
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