Circulation, Vol 78, 816-824, Copyright © 1988 by American Heart Association
MT La Rovere, G Specchia, A Mortara and PJ Schwartz
Experimental studies have shown that among dogs with a healed myocardial
infarction, depressed baroreflex sensitivity (BRS) identifies a subgroup at
higher risk for sudden death. We have examined the relation among BRS,
several clinical cardiovascular variables, and subsequent mortality in 78
patients below the age of 65 years who have had a first myocardial
infarction. BRS was assessed by calculating the regression line relating
phenylephrine-induced increases in systolic blood pressure to the attendant
changes in the RR interval. A reduced BRS primarily reflects an impairment
in the vagal efferent component of the baroreceptor reflexes. The BRS of
the entire population was 7.8 +/- 4.9 msec/mm Hg. BRS was lower among
patients with an inferior myocardial infarction (6.1 +/- 3.3 vs. 8.9 +/-
5.8 msec/mm Hg, p = 0.03), with a three- versus a one-vessel disease (4.8
+/- 2.7 vs. 7.1 +/- 3.1 msec/mm Hg, p = 0.04), and with episodes of
ventricular tachycardia (5.1 +/- 3.0 vs. 8.3 +/- 5.1, p = 0.03). There was
no correlation between BRS and left ventricular ejection fraction or with
mean pulmonary capillary wedge pressure at peak exercise, but a correlation
(r = 0.35, p less than 0.001) was present with exercise tolerance. During
the 24 months mean follow-up period, there were six cardiovascular deaths
(7.6%), and four were sudden.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Baroreflex sensitivity, clinical correlates, and cardiovascular mortality among patients with a first myocardial infarction. A prospective study
Divisione di Cardiologia Centro Medico Montescano, Fondazione Clinica del Lavoro, IRCCS, Pavia, Italy.
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