Distinction between arrhythmic and nonarrhythmic death after acute myocardial infarction based on heart rate variability, signal-averaged electrocardiogram, ventricular arrhythmias and left ventricular ejection fraction
We investigated whether heart rate variability, the signal-averaged electrocardiogram (ECG), ventricular arrhythmias and left ventricular ejection fraction predict the mechanism of cardiac death after myocardial infarction. Postinfarction risk stratification studies have almost exclusively focused o...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1996-08, Vol.28 (2), p.296-304 |
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| creator | Hartikainen, Juha E.K. Malik, Marek Staunton, Anne Poloniecki, Jan Camm, A. John |
| description | We investigated whether heart rate variability, the signal-averaged electrocardiogram (ECG), ventricular arrhythmias and left ventricular ejection fraction predict the mechanism of cardiac death after myocardial infarction.
Postinfarction risk stratification studies have almost exclusively focused on predicting the risk of arrhythmic death. The factors that identify and distinguish persons at risk for arrhythmic and nonarrhythmic death are poorly known.
Heart rate variability, the signal-averaged ECG, ventricular arrhythmias and left ventricular ejection fraction were assessed in 575 survivors of acute myocardial infarction. The patients were followed up for 2 years; arrhythmic and nonarrhythmic cardiac deaths were used as clinical end points. During the follow-up period, 47 cardiac deaths occurred, 29 (62%) arrhythmic and 18 (38%) nonarrhythmic.
All risk factors were associated with cardiac mortality in univariate analysis. With the exception of left ventricular ejection fraction, they were also predictors of arrhythmic death. Depressed heart rate variability (p < 0.001), ventricular ectopic beats (p < 0.001) and low ejection fraction (p < 0.001) were related to nonarrhythmic death. In multivariate analysis, depressed heart rate variability (p < 0.001) and runs of ventricular tachycardia (p < 0.05) predicted arrhythmic death. Nonarrhythmic death was associated with depressed heart rate variability (p < 0.001), ventricular ectopic beats (p < 0.001) and low ejection fraction (p < 0.01). By selecting patients with depressed heart rate variability, long filtered QRS duration or ventricular arrhythmias and excluding patients with the lowest ejection fraction, we identified a group in which 75% of deaths were arrhythmic. Similarly, by selecting patients with a low ejection fraction and excluding patients with the lowest heart rate variability, we identified a group in which 75% of deaths were nonarrhythmic.
Arrhythmic death was associated predominantly with depressed heart rate variability and ventricular tachycardia runs, and nonarrhythmic death with low ejection fraction, ventricular ectopic beats and depressed heart rate variability. A combination of risk factors identified patient groups in which a majority of deaths were either arrhythmic or nonarrhythmic. |
| doi_str_mv | 10.1016/0735-1097(96)00169-6 |
| format | Article |
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Postinfarction risk stratification studies have almost exclusively focused on predicting the risk of arrhythmic death. The factors that identify and distinguish persons at risk for arrhythmic and nonarrhythmic death are poorly known.
Heart rate variability, the signal-averaged ECG, ventricular arrhythmias and left ventricular ejection fraction were assessed in 575 survivors of acute myocardial infarction. The patients were followed up for 2 years; arrhythmic and nonarrhythmic cardiac deaths were used as clinical end points. During the follow-up period, 47 cardiac deaths occurred, 29 (62%) arrhythmic and 18 (38%) nonarrhythmic.
All risk factors were associated with cardiac mortality in univariate analysis. With the exception of left ventricular ejection fraction, they were also predictors of arrhythmic death. Depressed heart rate variability (p < 0.001), ventricular ectopic beats (p < 0.001) and low ejection fraction (p < 0.001) were related to nonarrhythmic death. In multivariate analysis, depressed heart rate variability (p < 0.001) and runs of ventricular tachycardia (p < 0.05) predicted arrhythmic death. Nonarrhythmic death was associated with depressed heart rate variability (p < 0.001), ventricular ectopic beats (p < 0.001) and low ejection fraction (p < 0.01). By selecting patients with depressed heart rate variability, long filtered QRS duration or ventricular arrhythmias and excluding patients with the lowest ejection fraction, we identified a group in which 75% of deaths were arrhythmic. Similarly, by selecting patients with a low ejection fraction and excluding patients with the lowest heart rate variability, we identified a group in which 75% of deaths were nonarrhythmic.
Arrhythmic death was associated predominantly with depressed heart rate variability and ventricular tachycardia runs, and nonarrhythmic death with low ejection fraction, ventricular ectopic beats and depressed heart rate variability. A combination of risk factors identified patient groups in which a majority of deaths were either arrhythmic or nonarrhythmic.]]></description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/0735-1097(96)00169-6</identifier><identifier>PMID: 8800101</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Biological and medical sciences ; Cardiology. Vascular system ; Coronary heart disease ; Electrocardiography ; Female ; Heart ; Heart Rate - physiology ; Humans ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction - complications ; Myocardial Infarction - mortality ; Risk Assessment ; Risk Factors ; Signal Processing, Computer-Assisted ; Stroke Volume - physiology ; Tachycardia, Ventricular - etiology ; Tachycardia, Ventricular - mortality ; Ventricular Function, Left - physiology ; Ventricular Premature Complexes - etiology ; Ventricular Premature Complexes - mortality</subject><ispartof>Journal of the American College of Cardiology, 1996-08, Vol.28 (2), p.296-304</ispartof><rights>1996 American College of Cardiology</rights><rights>1996 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c352t-240d2c51ac6dede58c8b442e57efa8afa10c21b614f02ee4a61227b45502d9c83</citedby><cites>FETCH-LOGICAL-c352t-240d2c51ac6dede58c8b442e57efa8afa10c21b614f02ee4a61227b45502d9c83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/0735109796001696$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3174516$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8800101$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hartikainen, Juha E.K.</creatorcontrib><creatorcontrib>Malik, Marek</creatorcontrib><creatorcontrib>Staunton, Anne</creatorcontrib><creatorcontrib>Poloniecki, Jan</creatorcontrib><creatorcontrib>Camm, A. John</creatorcontrib><title>Distinction between arrhythmic and nonarrhythmic death after acute myocardial infarction based on heart rate variability, signal-averaged electrocardiogram, ventricular arrhythmias and left ventricular ejection fraction</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description><![CDATA[We investigated whether heart rate variability, the signal-averaged electrocardiogram (ECG), ventricular arrhythmias and left ventricular ejection fraction predict the mechanism of cardiac death after myocardial infarction.
Postinfarction risk stratification studies have almost exclusively focused on predicting the risk of arrhythmic death. The factors that identify and distinguish persons at risk for arrhythmic and nonarrhythmic death are poorly known.
Heart rate variability, the signal-averaged ECG, ventricular arrhythmias and left ventricular ejection fraction were assessed in 575 survivors of acute myocardial infarction. The patients were followed up for 2 years; arrhythmic and nonarrhythmic cardiac deaths were used as clinical end points. During the follow-up period, 47 cardiac deaths occurred, 29 (62%) arrhythmic and 18 (38%) nonarrhythmic.
All risk factors were associated with cardiac mortality in univariate analysis. With the exception of left ventricular ejection fraction, they were also predictors of arrhythmic death. Depressed heart rate variability (p < 0.001), ventricular ectopic beats (p < 0.001) and low ejection fraction (p < 0.001) were related to nonarrhythmic death. In multivariate analysis, depressed heart rate variability (p < 0.001) and runs of ventricular tachycardia (p < 0.05) predicted arrhythmic death. Nonarrhythmic death was associated with depressed heart rate variability (p < 0.001), ventricular ectopic beats (p < 0.001) and low ejection fraction (p < 0.01). By selecting patients with depressed heart rate variability, long filtered QRS duration or ventricular arrhythmias and excluding patients with the lowest ejection fraction, we identified a group in which 75% of deaths were arrhythmic. Similarly, by selecting patients with a low ejection fraction and excluding patients with the lowest heart rate variability, we identified a group in which 75% of deaths were nonarrhythmic.
Arrhythmic death was associated predominantly with depressed heart rate variability and ventricular tachycardia runs, and nonarrhythmic death with low ejection fraction, ventricular ectopic beats and depressed heart rate variability. A combination of risk factors identified patient groups in which a majority of deaths were either arrhythmic or nonarrhythmic.]]></description><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Myocardial Infarction - complications</subject><subject>Myocardial Infarction - mortality</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Signal Processing, Computer-Assisted</subject><subject>Stroke Volume - physiology</subject><subject>Tachycardia, Ventricular - etiology</subject><subject>Tachycardia, Ventricular - mortality</subject><subject>Ventricular Function, Left - physiology</subject><subject>Ventricular Premature Complexes - etiology</subject><subject>Ventricular Premature Complexes - mortality</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhi0EKkvhH4DkA0JFasBO4nxckFD5lCpxgbM1sSe7rhKnjJ1F-1v5M3Wa1QIXTh7PPPN6PC9jz6V4I4Ws3oq6UJkUbX3RVq9FyrRZ9YBtpFJNVqi2fsg2J-QxexLCjRCiamR7xs6aJjUIuWG_P7gQnTfRTZ53GH8heg5Eu0Pcjc5w8Jb7yf-VsQhxx6GPSBzMHJGPh8kAWQcDd74HOopBQMtTsEOgyAkSuQdy0LnBxcMlD27rYchgjwTbhOKAJtIqNW0Jxku-Rx_JmXkA-jMUhPupBuzjPwDe4PpyT3AfPGWPehgCPjue5-zHp4_fr75k198-f716f52ZQuUxy0thc6MkmMqiRdWYpivLHFWNPTTQgxQml10ly17kiCVUMs_rrlRK5LY1TXHOXq26tzT9nDFEPbpgcBjA4zQHXTdF0bRtlcByBQ1NIRD2-pbcCHTQUujFU70YphfDdJsui6d6aXtx1J-7Ee2p6Whiqr881iEYGNL3vXHhhBWyLpVcZN6tGKZd7B2SDsahN2gdpc1pO7n_z3EHLP7FUA</recordid><startdate>19960801</startdate><enddate>19960801</enddate><creator>Hartikainen, Juha E.K.</creator><creator>Malik, Marek</creator><creator>Staunton, Anne</creator><creator>Poloniecki, Jan</creator><creator>Camm, A. John</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19960801</creationdate><title>Distinction between arrhythmic and nonarrhythmic death after acute myocardial infarction based on heart rate variability, signal-averaged electrocardiogram, ventricular arrhythmias and left ventricular ejection fraction</title><author>Hartikainen, Juha E.K. ; Malik, Marek ; Staunton, Anne ; Poloniecki, Jan ; Camm, A. John</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c352t-240d2c51ac6dede58c8b442e57efa8afa10c21b614f02ee4a61227b45502d9c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Myocardial Infarction - complications</topic><topic>Myocardial Infarction - mortality</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Signal Processing, Computer-Assisted</topic><topic>Stroke Volume - physiology</topic><topic>Tachycardia, Ventricular - etiology</topic><topic>Tachycardia, Ventricular - mortality</topic><topic>Ventricular Function, Left - physiology</topic><topic>Ventricular Premature Complexes - etiology</topic><topic>Ventricular Premature Complexes - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hartikainen, Juha E.K.</creatorcontrib><creatorcontrib>Malik, Marek</creatorcontrib><creatorcontrib>Staunton, Anne</creatorcontrib><creatorcontrib>Poloniecki, Jan</creatorcontrib><creatorcontrib>Camm, A. John</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hartikainen, Juha E.K.</au><au>Malik, Marek</au><au>Staunton, Anne</au><au>Poloniecki, Jan</au><au>Camm, A. John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distinction between arrhythmic and nonarrhythmic death after acute myocardial infarction based on heart rate variability, signal-averaged electrocardiogram, ventricular arrhythmias and left ventricular ejection fraction</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1996-08-01</date><risdate>1996</risdate><volume>28</volume><issue>2</issue><spage>296</spage><epage>304</epage><pages>296-304</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract><![CDATA[We investigated whether heart rate variability, the signal-averaged electrocardiogram (ECG), ventricular arrhythmias and left ventricular ejection fraction predict the mechanism of cardiac death after myocardial infarction.
Postinfarction risk stratification studies have almost exclusively focused on predicting the risk of arrhythmic death. The factors that identify and distinguish persons at risk for arrhythmic and nonarrhythmic death are poorly known.
Heart rate variability, the signal-averaged ECG, ventricular arrhythmias and left ventricular ejection fraction were assessed in 575 survivors of acute myocardial infarction. The patients were followed up for 2 years; arrhythmic and nonarrhythmic cardiac deaths were used as clinical end points. During the follow-up period, 47 cardiac deaths occurred, 29 (62%) arrhythmic and 18 (38%) nonarrhythmic.
All risk factors were associated with cardiac mortality in univariate analysis. With the exception of left ventricular ejection fraction, they were also predictors of arrhythmic death. Depressed heart rate variability (p < 0.001), ventricular ectopic beats (p < 0.001) and low ejection fraction (p < 0.001) were related to nonarrhythmic death. In multivariate analysis, depressed heart rate variability (p < 0.001) and runs of ventricular tachycardia (p < 0.05) predicted arrhythmic death. Nonarrhythmic death was associated with depressed heart rate variability (p < 0.001), ventricular ectopic beats (p < 0.001) and low ejection fraction (p < 0.01). By selecting patients with depressed heart rate variability, long filtered QRS duration or ventricular arrhythmias and excluding patients with the lowest ejection fraction, we identified a group in which 75% of deaths were arrhythmic. Similarly, by selecting patients with a low ejection fraction and excluding patients with the lowest heart rate variability, we identified a group in which 75% of deaths were nonarrhythmic.
Arrhythmic death was associated predominantly with depressed heart rate variability and ventricular tachycardia runs, and nonarrhythmic death with low ejection fraction, ventricular ectopic beats and depressed heart rate variability. A combination of risk factors identified patient groups in which a majority of deaths were either arrhythmic or nonarrhythmic.]]></abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>8800101</pmid><doi>10.1016/0735-1097(96)00169-6</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Cardiology. Vascular system Coronary heart disease Electrocardiography Female Heart Heart Rate - physiology Humans Male Medical sciences Middle Aged Multivariate Analysis Myocardial Infarction - complications Myocardial Infarction - mortality Risk Assessment Risk Factors Signal Processing, Computer-Assisted Stroke Volume - physiology Tachycardia, Ventricular - etiology Tachycardia, Ventricular - mortality Ventricular Function, Left - physiology Ventricular Premature Complexes - etiology Ventricular Premature Complexes - mortality |
| title | Distinction between arrhythmic and nonarrhythmic death after acute myocardial infarction based on heart rate variability, signal-averaged electrocardiogram, ventricular arrhythmias and left ventricular ejection fraction |
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