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Titolo:
BAROREFLEX SENSITIVITY AND HEART-RATE-VARIABILITY IN PREDICTION OF TOTAL CARDIAC MORTALITY AFTER MYOCARDIAL-INFARCTION
Autore:
LAROVERE MT; BIGGER JT; MARCUS FI; MORTARA A; SCHWARTZ PJ;
Indirizzi:
FDN SALVATORE MAUGERI,CTR MED MONTESCANO,VIA MONTESCANO I-27040 MONTESCANO PV ITALY COLUMBIA UNIV COLL PHYS & SURG,DEPT MED,DIV CARDIOL NEW YORK NY 10032 UNIV ARIZONA,HLTH SCI CTR,DEPT INTERNAL MED,CARDIOL SECT TUCSON AZ 00000 UNIV PAVIA,DEPT CARDIOL I-27100 PAVIA ITALY IRCCS,POLICLIN SAN MATTEO PAVIA ITALY
Titolo Testata:
Lancet
fascicolo: 9101, volume: 351, anno: 1998,
pagine: 478 - 484
SICI:
0140-6736(1998)351:9101<478:BSAHIP>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
CONSCIOUS DOGS; SUDDEN-DEATH; VENTRICULAR-FIBRILLATION; AUTONOMIC MECHANISMS; PERIOD VARIABILITY; VAGAL REFLEXES; ISCHEMIA; EXERCISE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
32
Recensione:
Indirizzi per estratti:
Citazione:
M.T. Larovere et al., "BAROREFLEX SENSITIVITY AND HEART-RATE-VARIABILITY IN PREDICTION OF TOTAL CARDIAC MORTALITY AFTER MYOCARDIAL-INFARCTION", Lancet, 351(9101), 1998, pp. 478-484

Abstract

Background Experimental evidence suggests that autonomic markers suchas heart-rate variabillity and baroreflex sensitivity (BRS) may contribute to post-infarction risk stratification. There are clinical data to support this concept for heart-rate variability. The main objectiveof the ATRAMI study was to provide prospective data on the additionaland independent prognostic value for cardiac mortality of heart-rate variability and BRS in patients after myocardial infarction in whom left-ventricular ejection fraction (LVEF) and ventricular arrhythmias were known. Methods This multicentre international prospective study enrolled 1284 patients with a recent (<28 days) myocardial infarction. 24h Holter recording was done to quantify heart-rate variability (measured as standard deviation of normal to normal RR intervals [SDNN]) andventricular arrhythmias. BRS was calculated from measurement of the rate-pressure response to intravenous phenylephrine. Findings During 21(SD 8) months of follow-up, the primary endpoint, cardiac mortality, included 44 cardiac deaths and five non-fatal cardiac arrests. Low values of either heart-rate variability (SDNN <70 ms) or BRS (<3.0 ms permm Hg) carried a significant multivariate risk of cardiac mortality (3.2 [95% CI 1.42-7.36] and 28 [1.24-6.16], respectively). The association of low SDNN and BRS further increased risk; the 2-year mortality was 17% when both were below the cut-offs and 2% (p<0.0001) when both were well preserved (SDNN >105 ms, BRS >6.1 ms per mm Hg). The association of low SDNN or BRS with LVEF below 35% carried a relative risk of 6.7 (3.1-14.6) or 8.7 (4.3-17.6), respectively, compared with patientswith LVEF above 35% and less compromised SDNN (greater than or equal to 70 ms) and BRS(greater than or equal to 3 ms per mm Hg). Interpretation ATRAMI provides clinical evidence that after myocardial infarction the analysis of vagal reflexes Experimental evidence suggests that markers such as heart-rate variability and sensitivity (BRS) may contribute to poslobjective has significant prognostic value independently of LVEF and of ventricular arrhythmias and that it significantly adds to the prognostic value of heart-rate variability.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 06:14:53