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Circulation, Vol 69, 250-258, Copyright © 1984 by American Heart Association
JT Bigger Jr, JL Fleiss, R Kleiger, JP Miller and LM Rolnitzky
We examined the relationships among ventricular arrhythmias, left
ventricular dysfunction, and mortality after the occurrence of myocardial
infarction in 766 patients who enrolled in a nine-hospital study and
underwent two special tests. Frequency and repetitiveness of ventricular
premature depolarizations (VPDs) were determined by computer analysis of
predischarge 24 hr electrocardiographic recordings. The left ventricular
ejection fraction (LVEF) was determined by radionuclide ventriculography
and dichotomized at its optimal value of 30%. Frequency of VPDs was divided
into three categories: (1) less than one per hour, (2) one to 2.9 per hour,
and (3) three or more per hour. Repetitiveness of VPDs was also divided
into three categories: (1) no repetitive VPDs, (2) paired VPDs, and (3) VPD
runs. These variables were related, one at a time and jointly, to total
mortality and to deaths caused by arrhythmias. The hazard ratios for dying
in the higher or highest risk stratum vs the lower or lowest stratum for
each variable (adjusted for the effects of the others) were: LVEF below
30%, 3.5; VPD runs, 1.9; and VPD frequency of three or more per hour, 2.0.
There were no significant interactions among the three variables with
respect to effects on the risk of mortality. There was a suggestion of an
interaction between each risk variable and time after infarction. LVEF
below 30% was a better predictor of early mortality (less than 6 months)
and the presence of ventricular arrhythmias was a better predictor of late
mortality (after 6 months).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction
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