Multi-scale heart rate dynamics detected by phase-rectified signal averaging predicts mortality after acute myocardial infarction

Masaya Kisohara, Phyllis K. Stein, Yutaka Yoshida, Mari Suzuki, Narushi Iizuka, Robert M. Carney, Lana L. Watkins, Kenneth E. Freedland, James A. Blumenthal, Junichiro Hayano

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

AimsAcceleration 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 resultsWe 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 (ACconv and DCconv) that were calculated with (T,s) = [1,2 (beat)]. During the follow-up, 47 patients died. Both increased ACconv and decreased DCconv 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 ACconv (P = 0.020) and DCconv (P = 0.028), but the predictive power of AC at (30,60) was no longer significant.ConclusionA 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 ACconv and DCconv for beat-to-beat short-term heart rate dynamics.

Original languageEnglish
Pages (from-to)437-443
Number of pages7
JournalEuropace
Volume15
Issue number3
DOIs
Publication statusPublished - 03-2013
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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