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Turbulence Slope After Atrial Premature Complexes Is an Independent Predictor of Mortality in Survivors of Acute Myocardial Infarction
Author(s) -
WICHTERLE DAN,
CAMM A. JOHN,
MALIK MAREK
Publication year - 2004
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2004.03610.x
Subject(s) - medicine , cardiology , myocardial infarction , atrial fibrillation
Heart rate turbulence is a potent postinfarction risk predictor that originally was investigated when it was triggered by ventricular premature complexes. Similar heart rate response is present after atrial premature complexes. “Atrial” turbulence slope (TS A ) moderately correlates with “ventricular” turbulence slope (TS V ). This study investigated the value of TS A assessed in 24‐hour Holter recordings for postinfarction risk stratification. Methods and Results: Predictive power of TS A was investigated in the placebo arm of the European Myocardial Infarction Amiodarone Trial, which enrolled patients surviving acute myocardial infarction with left ventricular ejection fraction (LVEF) ≤40%. Of 633 patients with available 24‐hour Holter recordings, 87 died during the follow‐up period of 662 ± 105 days. The same methodology was used to calculate TS A and TS V . TS A was significantly lower in nonsurvivors compared to survivors (2.0 ± 2.7 vs 3.0 ± 3.3 msec/RR, P = 0.014). TS A ≤0.8 msec/RR was associated with relative risk all‐cause mortality of 2.5 (95% confidence interval 1.6–3.9, P = 0.000046). In a multivariate Cox regression model including age, LVEF, QRS duration, mean RR interval, heart rate variability index, presence of nonsustained ventricular tachycardia, and TS V , TS A remained a significant predictor of total mortality with relative risk of 2.0 (95% confidence interval 1.2–3.4, P = 0.014). Conclusion: TS A is a significant and independent predictor of all‐cause mortality in postinfarction patients with left ventricular dysfunction.