Circulation, Vol 90, 108-113, Copyright © 1994 by American Heart Association
D Bonaduce, F Marciano, M Petretta, ML Migaux, G Morgano, V Bianchi, L Salemme, G Valva and M Condorelli
BACKGROUND: Heart period variability provides useful prognostic information
on autonomic cardiac control, and a strong association has been
demonstrated after myocardial infarction (MI) between cardiac mortality,
sudden death, and reduced total power, ultralow-frequency (ULF) power, and
very-low-frequency (VLF) power. Converting enzyme inhibitors are widely
used in MI patients, but their influence on heart period variability
remains to be defined. METHODS AND RESULTS: Time- and frequency-domain
measures of heart period variability were calculated from 24-hour Holter
monitoring in 40 patients with a first uncomplicated MI. After baseline
examination between 48 and 72 hours after symptom onset, patients were
randomly assigned to placebo or captopril administration, and on the third
day, 24-hour Holter monitoring was repeated. No changes in time and
frequency domain were detectable after placebo. After captopril, the SD of
all normal RR (NN) intervals (SDNN) increased from 90 +/- 29 to 105 +/- 30
milliseconds (P < .01); the SD of the average NN intervals for all
5-minute segments (SDANN index) and the mean of the SDs of all NN intervals
for all 5- minute segments (SDNN index) also increased from 74 +/- 24 to 90
+/- 26 milliseconds (P < .01) and from 45 +/- 17 to 49 +/- 15
milliseconds (P < .05), respectively. The root mean square successive
difference (r- MSSD) and the percent of differences between adjacent NN
intervals > 50 milliseconds (pNN50) remained unchanged. In regard to
frequency-domain measures, after captopril, total power (ln unit) increased
from 8.28 +/- 0.42 to 8.47 +/- 0.30 (P < .01); considering the frequency
bands, a significant increase was observed in ULF (P < .01), VLF (P <
.05), and low-frequency (LF) power (P < .05), whereas high-frequency
(HF) power remained unchanged. CONCLUSIONS: This study supports the
hypothesis that the renin-angiotensin system modulates the amplitude of ULF
and VLF power. Furthermore, it demonstrates that in MI patients, converting
enzyme inhibition favorably modifies measures of heart period variability
strongly associated with a poor prognosis.
ARTICLES
Effects of converting enzyme inhibition on heart period variability in patients with acute myocardial infarction
Institute of Internal Medicine, Cardiology, and Heart Surgery, University of Naples Federico II, Italy.
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