February 1, 1998The Lancet3,123 citationsOpen Access
Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction
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Key Result
Low heart-rate variability (<70 ms) and baroreflex sensitivity (<3.0 ms/mmHg) independently predicted post-infarction cardiac mortality, increasing 2-year mortality to 17% when both were low.
Key Points
- Assess the prognostic value of heart-rate variability and baroreflex sensitivity for cardiac mortality after myocardial infarction.
- Multicenter international prospective study
- Enrolled 1284 patients with recent myocardial infarction
- Used 24-hour Holter recording for heart-rate variability and phenylephrine for baroreflex sensitivity measurement.
- Observed 44 cardiac deaths and 5 non-fatal cardiac arrests during follow-up.
- Low heart-rate variability and baroreflex sensitivity both significantly increased the risk of cardiac mortality.
- Two-year mortality was 17% with low values of both metrics compared to just 2% with preserved values.
Structured PICO
Do low heart-rate variability and baroreflex sensitivity predict cardiac mortality in patients with recent myocardial infarction?
P
Population
1284 patients with a recent (<28 days) myocardial infarction
I
Intervention
Measurement of heart-rate variability (SDNN) via 24 h Holter recording and baroreflex sensitivity (BRS) via rate-pressure response to intravenous phenylephrine
C
Comparator
Patients with preserved heart-rate variability (SDNN >105 ms) and BRS (>6.1 ms per mm Hg)
O
Outcome
Cardiac mortality (cardiac deaths and non-fatal cardiac arrests) during 21 (SD 8) months of follow-uphard clinical
Low heart-rate variability and baroreflex sensitivity are independent predictors of cardiac mortality after recent myocardial infarction, adding prognostic value beyond LVEF and ventricular arrhythmias.
Abstract
SummaryBackgroundExperimental evidence suggests that autonomic markers such as heart-rate variability and baroreflex sensitivity (BRS) may contribute to post-infarction risk stratification. There are clinical data to support this concept for heart-rate variability. The main objective of the ATRAMI study was to provide prospective data on the additional and independent prognostic value for cardiac mortality of heart-rate variability and BRS in patients after myocardial infarction in whom left-ventricular ejection fraction (LVEF) and ventricular arrhythmias were known.MethodsThis multicentre international prospective study enrolled 1284 patients with a recent (FindingsDuring 21 (SD 8) months of follow-up, the primary endpoint, cardiac mortality, included 44 cardiac deaths and five non-fatal cardiac arrests. Low values of either heart-rate variability (SDNN 105 ms, BRS >6·1 ms per mm Hg). The association of low SDNN or BRS with LVEF below 35% carried a relative risk of 6·7 (3·1–14·6) or 8·7 (4·3–17·6), respectively, compared with patients with LVEF above 35% and less compromised SDNN (≥70 ms) and BRS (≥3 ms per mm Hg).InterpretationATRAMI provides clinical evidence that after myocardial infarction the analysis of vagal reflexes has significant prognostic value independently of LVEF and of ventricular arrhythmias and that it significantly adds to the prognostic value of heart-rate variability.
Cite This Study
Rovere et al. (1998) studied this question. Low heart-rate variability (<70 ms) and baroreflex sensitivity (<3.0 ms/mmHg) independently predicted post-infarction cardiac mortality, increasing 2-year mortality to 17% when both were low.