PMID- 14760330
OWN - NLM
STAT- MEDLINE
DCOM- 20040326
LR  - 20190626
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 147
IP  - 2
DP  - 2004 Feb
TI  - Including patients with diabetes mellitus or coronary artery bypass grafting 
      decreases the association between heart rate variability and mortality after 
      myocardial infarction.
PG  - 309-16
AB  - BACKGROUND: Decreased heart rate variability (HRV) is often assumed to be 
      associated with mortality in all patients after myocardial infarction (MI), 
      independent of clinical factors or time after MI. METHOD: HRV was determined from 
      Holter tapes in the Cardiac Arrhythmia Suppression Trial (CAST). Patients were 71 
      +/- 120 days after MI. A total of 735 pre-therapy tapes were analyzed in patients 
      who had ventricular premature contractions (VPCs) suppressed on the first 
      treatment. The period of follow-up was 362 +/- 243 days (69 deaths). The 
      association of clinical and demographic factors and 24-hour, daytime, and 
      nighttime HRV to mortality in all patients, patients without coronary artery 
      bypass graft (CABG) surgery between the qualifying MI and the Holter monitoring, 
      and patients with neither CABG nor diabetes mellitus was determined with 
      univariate Cox regression analysis. RESULTS: For the entire group and the 
      subgroup without CABG, the strongest association was with increased daytime 
      normalized high frequency power (NHF day). Further excluding patients with 
      diabetes mellitus strengthened the association of HRV with mortality rate. 
      Decreased natural logarithm (ln) 24-hour total and ultra low frequency (ULF) 
      power were the strongest predictors of mortality. The best cutoff point for ln 
      ULF for separating survivors and non-survivors was determined. After including a 
      history of MI, congestive heart failure, or both as co-factors, ln ULF < or =7.85 
      identified patients at approximately 4-times the relative risk of mortality, but 
      did not risk-stratify patients without prior MI or history of congestive heart 
      failure. CONCLUSIONS: HRV predicts mortality rate in a broad range of times after 
      MI. Excluding patients with CABG after MI or with diabetes mellitus significantly 
      strengthens the association of HRV with mortality. HRV measures beyond the 
      peri-infarction period, with clinical factors, can identify subgroups at an 
      elevated risk of mortality.
FAU - Stein, Phyllis K
AU  - Stein PK
AD  - Cardiovascular Division, Department of Medicine, Washington University School of 
      Medicine, St. Louis, Mo 63108, USA. pstein@im.wustl.edu
FAU - Domitrovich, Peter P
AU  - Domitrovich PP
FAU - Kleiger, Robert E
AU  - Kleiger RE
CN  - CAST Investigators
LA  - eng
GR  - R0-3 HL 53776/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Anti-Arrhythmia Agents)
SB  - IM
MH  - Analysis of Variance
MH  - Anti-Arrhythmia Agents/therapeutic use
MH  - *Coronary Artery Bypass
MH  - *Diabetes Complications
MH  - Electrocardiography, Ambulatory
MH  - Female
MH  - Heart Rate/*physiology
MH  - Humans
MH  - Male
MH  - Myocardial Infarction/complications/*mortality/physiopathology/surgery
MH  - Prognosis
MH  - Survival Analysis
MH  - Ventricular Premature Complexes/diagnosis/drug therapy/etiology
EDAT- 2004/02/05 05:00
MHDA- 2004/03/27 05:00
CRDT- 2004/02/05 05:00
PHST- 2004/02/05 05:00 [pubmed]
PHST- 2004/03/27 05:00 [medline]
PHST- 2004/02/05 05:00 [entrez]
AID - S0002870303005209 [pii]
AID - 10.1016/s0002-8703(03)00520-9 [doi]
PST - ppublish
SO  - Am Heart J. 2004 Feb;147(2):309-16. doi: 10.1016/s0002-8703(03)00520-9.