Circulation, Vol 85, 164-171, Copyright © 1992 by American Heart Association
JT Bigger Jr, JL Fleiss, RC Steinman, LM Rolnitzky, RE Kleiger and JN Rottman
BACKGROUND. We studied 715 patients 2 weeks after myocardial infarction to
establish the associations between six frequency domain measures of heart
period variability (HPV) and mortality during 4 years of follow- up.
METHODS AND RESULTS. Each measure of HPV had a significant and at least
moderately strong univariate association with all-cause mortality, cardiac
death, and arrhythmic death. Power in the lower- frequency bands--ultra low
frequency (ULF) and very low frequency (VLF) power--had stronger
associations with all three mortality end points than power in the
higher-frequency bands--low frequency (LF) and high frequency (HF) power.
The 24-hour total power also had a significant and strong association with
all three mortality end points. VLF power was the only variable that was
more strongly associated with arrhythmic death than with cardiac death or
all-cause mortality. In multivariate Cox regression models using a step-up
approach to evaluate the independent associations between frequency domain
measures of heart period variability and death of all causes, ULF power was
selected first (i.e., was the single component with the strongest
association). Adding VLF or LF power to the Cox regression model
significantly improved the prediction of outcome. With both ULF and VLF
power in the Cox regression model, the addition of the other two
components, LF and HF power, singly or together, did not significantly
improve the prediction of all-cause mortality. We explored the relation
between the heart period variability measures and all-cause mortality,
cardiac death, and arrhythmic death before and after adjusting for five
previously established postinfarction risk predictors: age, New York Heart
Association functional class, rales in the coronary care unit, left
ventricular ejection fraction, and ventricular arrhythmias detected in a
24-hour Holter ECG recording. CONCLUSIONS. After adjustment for the five
risk predictors, the association between mortality and total, ULF, and VLF
power remained significant and strong, whereas LF and HF power were only
moderately strongly associated with mortality. The tendency for VLF power
to be more strongly associated with arrhythmic death than with all-cause or
cardiac death was still evident after adjusting for the five covariates.
Adding measures of HPV to previously known predictors of risk after
myocardial infarction identifies small subgroups with a 2.5- year mortality
risk of approximately 50%.
ARTICLES
Frequency domain measures of heart period variability and mortality after myocardial infarction
Department of Medicine, School of Public Health, Columbia University, New York, N.Y. 10032.
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