Multi-scale heart rate dynamics detected by phase-rectified signal averaging predicts mortality after acute myocardial infarction.
Journal Article (Journal Article)
AIMS: Acceleration and deceleration capacity (AC and DC) for beat-to-beat short-term heart rate dynamics are powerful predictors of mortality after acute myocardial infarction (AMI). We examined if AC and DC for minute-order long-term heart rate dynamics also have independent predictive value. METHODS AND RESULTS: We studied 24-hr Holter electrcardiograms in 708 post-AMI patients who were followed up for up to 30 months thereafter. Acceleration capacity and DC was calculated with the time scales of T (window size defining heart rate) and s (wavelet scale) from 1 to 500 s and compared their prognostic values with conventional measures (AC(conv) and DC(conv)) that were calculated with (T,s) = [1,2 (beat)]. During the follow-up, 47 patients died. Both increased AC(conv) and decreased DC(conv) predicted mortality (C statistic, 0.792 and 0.797). Concordantly, sharp peaks of C statistics were observed at (T,s) = [2,7 (sec)] for both increased AC and decreased DC (0.762 and 0.768), but there were larger peaks of C statistics at around [30,60 (sec)] for both (0.783 and 0.796). The C statistic was greater for DC than AC at (30,60) (P = 0.0012). Deceleration capacity at (30,60) was a significant predictor even after adjusted for AC(conv) (P = 0.020) and DC(conv) (P = 0.028), but the predictive power of AC at (30,60) was no longer significant. CONCLUSION: A decrease in DC for minute-order long-term heart rate dynamics is a strong predictor for post-AMI mortality and the predictive power is independent of AC(conv) and DC(conv) for beat-to-beat short-term heart rate dynamics.
Full Text
Duke Authors
Cited Authors
- Kisohara, M; Stein, PK; Yoshida, Y; Suzuki, M; Iizuka, N; Carney, RM; Watkins, LL; Freedland, KE; Blumenthal, JA; Hayano, J
Published Date
- March 2013
Published In
Volume / Issue
- 15 / 3
Start / End Page
- 437 - 443
PubMed ID
- 23248218
Pubmed Central ID
- PMC3578673
Electronic International Standard Serial Number (EISSN)
- 1532-2092
Digital Object Identifier (DOI)
- 10.1093/europace/eus409
Language
- eng
Conference Location
- England