Maria Stella Fera, Alessandro
Carunchio, Andrea Mazza, Maurizio Burattini, Maria Margherita Matinelli, Vincenzo Ceci.
Division of Cardiology, S. Spirito Hospital, Rome, Italy
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Patients surviving acute myocardial infarction are
susceptible to heart failure, recurrence of angina, reinfarction, arrhythmias and sudden
cardiac death. Most deaths and heart failure occur in the first six months after
infarction. Analysis of heart rate variability (HRV) has provided a noninvasive method for
assessing autonomic influence on the heart. The predictive value of depressed heart rate
variability after myocardial infarction has been shown to be independent of other risk
factors, such as left ventricular ejection fraction, frequency of ventricular premature
complexes on the 24-h Holter recording and the presence of late potentials on
signal-averaged electrocardiogram. Decrease HRV has been found to be nearly as powerful as
a decrease in left ventricular ejection fraction to predict total cardiac mortality1. Late potentials, detected by use of the signal-averaged
ECG (SAECG), suggest the presence of slow conduction. The presence of an abnormal SAECG,
after myo-cardial infarction, portends a significantly increased risk for arrhythmic
events. However, data of the predictive values of SAECG for total cardiac mortality in
post-infarction risk stratification are contrasting. The influence of the type of
contractile disturbances and the extent of coronary artery lesions on SAECG remains
unclear. Uncertain is the role of HRV and SAECG in relation to the clinical deterioration
in patients with myocardial infarction and the correlation of these parameters with the
develop of heart failure and ischemic recurrences. The aim of this study was to evaluate
the prognostic value of HRV and SAECG for clinical deterioration (progressive heart
failure and ischemic recurrences) during the first year of follow-up after acute
myocardial infarction.
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