RT-211
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Non-invasive assessment of the
arrhythmogenic substrate after myocardial infarction in the thrombolytic era: GISSI-3
Arrhythmias Substudy
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Maurizio Del Greco, Giandomenico
Nollo*, Marcello Disertori, Giampietro Sanna**, Aldo Pietro Maggioni***, on behalf of
GISSI-3 Arrhythmias Substudy Investigators.
U.O. di Cardiologia, Ospedale S. Chiara, Trento, *Centro Materiali Biofisica
Medica, Istituto Trentino Cultura, Trento, **Ospedale Fatebenefratelli, Milano,
***Istituto Mario Negri, Milan, Italy
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Abstract
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GISSI-3 was a multicentric randomised clinical trial
performed to assess the efficacy of lisinopril, transdermal glyceryl trinitrate and their
combination in improving survival and ventricular function after acute myocardial
infarction (MI). In a subgroup of patients (Arrhythmias Substudy) we analysed before
hospital discharge the arrhythmogenic substrate by means of Holter recording (12 327 pts),
signal-averaged ECG (SAECG, 673 pts) and short-term heart rate variability (HRV, 324 pts)
analysis. Holter recordings were performed to assess the prevalence of ventricular ectopic
beats (VEB) (frequency of ventricular ectopic beats per hour and/or non sustained
ventricular tachycardia). SAECG was recorded to detected ventricular late potential (VLP)
using several commercial devices. QRS duration (QRSD), low amplitude signal duration (LAS
40) and root mean-square-voltage (RMS40), were measured with filters set at 40-250 Hz high
and low pass frequencies. Ten minutes of one lead ECG were recorded during the morning
with the patients in supine and basal conditions and simultaneously transmitted via
telephonic line to the Core laboratory, for RR interval measurement and data analysis.
Time and frequency domain HRV indexes (power spectral components: LF, HF, VLF, LF/HF) were
measured on 300 consecutive RR intervals.
In the population of the GISSI-3 study, patients treated with lisinopril presented at
six months a reduction in overall mortality and in the combined endpoint of mortality and
severe ventricular disfunction as compared with the rest of the population. On the other
hand the results of GISSI-3 Arrhythmias Substudy suggest that the beneficial effects of
early lisinopril treatment on prognosis after acute MI are not correlated to significant
changes of the arrhythmogenic substrate when evaluated before hospital discharge by 24-h
Holter monitoring for VEB prevalence, SAECG for VLP detection and short-term HRV for
assessment of the autonomic nervous control.
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Key Words
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Autonomic nervous system evaluation
GISSI-3 Arrhythmias subtrial, lisinopril, transdermal glyceryl trinitrate, arrhythmogenic
substrate, postmyocardial patients, ventricular function, mortality risk, Holter ECG, OA
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