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Circulation, Vol 85, 2073-2079, Copyright © 1992 by American Heart Association
GC Casolo, P Stroder, C Signorini, F Calzolari, M Zucchini, E Balli, A Sulla and S Lazzerini
BACKGROUND. After acute myocardial infarction (AMI), several abnormalities
of the autonomic control to the heart have been described. Heart rate (HR)
variability has been used to explore the neural control to the heart. A low
HR variability count measured 7-13 days after AMI is significantly related
to a poor outcome. Little information is available on HR variability early
after AMI and its relation to clinical and hemodynamic data. METHODS AND
RESULTS. We studied 54 consecutive patients (42 men and 12 women; mean age,
60.4 +/- 11 years) with evidence of AMI by collecting the 24-hour HR SD
from Holter tapes recorded on day 2 or 3. We also measured HR variability
in 15 patients with unstable angina and in 35 age-matched normal subjects.
HR variability was lower in AMI than in unstable angina patients (57.6 +/-
21.3 versus 92 +/- 19 msec; p less than 0.001) and controls (105 +/- 12
msec; p less than 0.001). Also, HR variability was greater in non-Q- wave
than in Q-wave AMI (p less than 0.0001) and in recombinant tissue- type
plasminogen activator-treated patients with respect to the rest of the
group (p less than 0.02). No difference was found for infarct site. HR
variability was significantly related to mean 24-hour HR, peak creatine
kinase-MB, and left ventricular ejection fraction (all p less than 0.0001).
Patients belonging to Killip class greater than I or who required the use
of diuretics or digitalis had lower counts (p less than 0.004, p less than
0.001, and p less than 0.024, respectively). Six patients died within 20
days after admission to the hospital. In these patients, HR variability was
lower than in survivors (31.2 +/- 12 versus 60.9 +/- 20 msec; p less than
0.001), and a value less than 50 msec was significantly associated with
mortality (p less than 0.025). CONCLUSIONS. HR variability during the early
phase of AMI is decreased and is significantly related to clinical and
hemodynamic indexes of severity. The causes for the observed changes in HR
variability during AMI may be reduced vagal and/or increased sympathetic
outflow to the heart. It is suggested that early measurements of HR
variability during AMI may offer important clinical information and
contribute to the early risk stratification of patients.
ARTICLES
Heart rate variability during the acute phase of myocardial infarction
Clinica Medica I, University of Florence, Italy.
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