Spontaneous baroreflex sensitivity: prospective validation trial of a novel technique in survivors of acute myocardial infarction

TY - JOUR

T1 - Spontaneous baroreflex sensitivity

T2 - prospective validation trial of a novel technique in survivors of acute myocardial infarction

AU - Barthel, Petra

AU - Bauer, Axel

AU - Müller, Alexander

AU - Huster, Katharina M

AU - Kanters, Jørgen K.

AU - Paruchuri, Vijayapraveena

AU - Yang, Xiaoyun

AU - Ulm, Kurt

AU - Malik, Marek

AU - Schmidt, Georg

N1 - Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

PY - 2012/8

Y1 - 2012/8

N2 - Background: Low baroreflex sensitivity (BRS) indicates poor prognosis after acute myocardial infarction. Noninvasive BRS assessment is complicated by nonstationarities and noise in electrocardiogram and pressure signals. Phase-rectified signal averaging is a novel signal processing technology overcoming these problems. Objective: To prospectively validate a BRS measure (baroreflex sensitivity assessed by means of phase-rectified signal averaging [BRSPRSA]) based on this technology. Methods: Nine hundred forty-one consecutive acute myocardial infarction survivors aged 80 years or younger in sinus rhythm were prospectively enrolled at 2 German university hospitals. All patients underwent 30-minute recordings of electrocardiogram and arterial blood pressures (Portapres; TNO-TPD Biomedical Instrumentation, Amsterdam, Netherlands) within the first 2 weeks after myocardial infarction. BRS PRSA was prospectively dichotomized at 1.58 ms/mm Hg. Primary end point was all-cause mortality at 5 years. Multivariable analyses included Global Registry of Acute Coronary Events score (dichotomized at <120), sex, BRSPRSA, left ventricular ejection fraction (dichotomized at ≤35%), and diabetes mellitus. BRSPRSA was compared with 3 standard noninvasive BRS measures, that is, the sequence method, the transfer function method, and the correlation method. Results: During follow-up, 72 patients (7.7%) died. BRSPRSA stratified the study population into a high-risk group of 405 patients (≤1.58 ms/mm Hg) with an estimated 5-year mortality of 14.2% and a low-risk group of 536 patients (>1.58 ms/mm Hg) with a 5-year mortality of 2.8% (P <.0001). On multivariable analysis, BRSPRSA ≤ 1.58 ms/mm Hg was associated with a hazard ratio of 3.1 (confidence interval 1.7-5.6; P =.001). Predictive power of BRSPRSA ≤ 1.58 ms/mm Hg was particularly strong in patients with a Global Registry of Acute Coronary Events score of <120 or with a left ventricular ejection fraction of ≤35%. Conclusion: BRSPRSA is a powerful and independent predictor of mortality in postinfarction patients especially when assessed in patients with a Global Registry of Acute Coronary Events score of <120 or a left ventricular ejection fraction of ≤35%.

AB - Background: Low baroreflex sensitivity (BRS) indicates poor prognosis after acute myocardial infarction. Noninvasive BRS assessment is complicated by nonstationarities and noise in electrocardiogram and pressure signals. Phase-rectified signal averaging is a novel signal processing technology overcoming these problems. Objective: To prospectively validate a BRS measure (baroreflex sensitivity assessed by means of phase-rectified signal averaging [BRSPRSA]) based on this technology. Methods: Nine hundred forty-one consecutive acute myocardial infarction survivors aged 80 years or younger in sinus rhythm were prospectively enrolled at 2 German university hospitals. All patients underwent 30-minute recordings of electrocardiogram and arterial blood pressures (Portapres; TNO-TPD Biomedical Instrumentation, Amsterdam, Netherlands) within the first 2 weeks after myocardial infarction. BRS PRSA was prospectively dichotomized at 1.58 ms/mm Hg. Primary end point was all-cause mortality at 5 years. Multivariable analyses included Global Registry of Acute Coronary Events score (dichotomized at <120), sex, BRSPRSA, left ventricular ejection fraction (dichotomized at ≤35%), and diabetes mellitus. BRSPRSA was compared with 3 standard noninvasive BRS measures, that is, the sequence method, the transfer function method, and the correlation method. Results: During follow-up, 72 patients (7.7%) died. BRSPRSA stratified the study population into a high-risk group of 405 patients (≤1.58 ms/mm Hg) with an estimated 5-year mortality of 14.2% and a low-risk group of 536 patients (>1.58 ms/mm Hg) with a 5-year mortality of 2.8% (P <.0001). On multivariable analysis, BRSPRSA ≤ 1.58 ms/mm Hg was associated with a hazard ratio of 3.1 (confidence interval 1.7-5.6; P =.001). Predictive power of BRSPRSA ≤ 1.58 ms/mm Hg was particularly strong in patients with a Global Registry of Acute Coronary Events score of <120 or with a left ventricular ejection fraction of ≤35%. Conclusion: BRSPRSA is a powerful and independent predictor of mortality in postinfarction patients especially when assessed in patients with a Global Registry of Acute Coronary Events score of <120 or a left ventricular ejection fraction of ≤35%.

KW - Aged

KW - Baroreflex

KW - Blood Pressure

KW - Diabetic Angiopathies

KW - Electrocardiography

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Infarction

KW - Patient Selection

KW - Prospective Studies

KW - ROC Curve

KW - Signal Processing, Computer-Assisted

U2 - 10.1016/j.hrthm.2012.04.017

DO - 10.1016/j.hrthm.2012.04.017

M3 - Journal article

C2 - 22516186

SN - 1547-5271

VL - 9

SP - 1288

EP - 1294

JO - Heart Rhythm

JF - Heart Rhythm

IS - 8

ER -