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Variability of Ventricular Premature Complexes and Mortality Risk
Author(s) -
Malik Marek,
Mercando Anthony D.,
SCHMIDT GEORG,
MORFILL GREGOR E.,
BARTHEL PETRA,
HADAMITZKY MARTIN,
KREUZBERG HEINZ,
DEMMEL VALENTIN,
SCHNEIDER RAPHAEL,
ULM KURT,
SCHÖMIG ALBERT
Publication year - 1996
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1996.tb03395.x
Subject(s) - medicine , ejection fraction , cardiology , coronary artery disease , sudden cardiac death , sudden death , heart rate variability , heart rate , heart failure , blood pressure
A method using a parameter from the field of nonlinear dynamics to quantify the variability of ventricular premature complexes (VPCs) is presented. One hundred patients with coronary artery disease and ≥ 10 VPCs/hour were included in the studv. The RR intervals were plotted in a three‐dimensional artificial phase space, and the structures in phase space were quantified by the local scaling indices, a. In the frequency distribution histogram, n(α), for each patient, the maximum of the ventricular ectopies αvpc, adjusted to the VPC frequency, was assessed; αvpc, was used as the risk indicator. Endpoints were total mortality and sudden cardiac death. During follow‐up (mean 3.1 years), 28 out of 100 patients died, 16 suddenly; αvpc had a significant prognostic impact end was independent from other risk indicators, such as left ventricular ejection fraction (LVEF). Patients who died during follow‐up were characterized by a high αvpc. The optimal discrimination of high risk patients and low risk patients occurred at αvpc — 3.0. After 4 years, the survival rate of patients with a αvpc > 3.0 was 59%, in contrast to 97% in patients with αvpc ≤ 0.3. As to the sudden death mortality, the survival rates were 74% and 97%, respectively. The difference between the groups were significant for both endpoints. Patients with an increased VPC variability (i.e., αvpc > 3.0) were at enhanced risk of sudden death and total mortality risk; αvpc was independent from other risk indicators such as the LVEF or heart rate variability parameters.