Prevalent low-frequency oscillation of heart rate: Novel predictor of mortality after myocardial infarction

Dan Wichterle, Jan Simek, Maria Teresa La Rovere, Peter J. Schwartz, A. John Camm, Marek Malik

Research output: Contribution to journalArticlepeer-review

Abstract

Background-This study evaluates a novel method for postinfarction risk stratification based on frequency-domain characteristics of heart rate variability (HRV) in 24-hour Holter recordings. Methods and Results-A new risk predictor, prevalent low-frequency oscillation (PLF), was determined in the placebo population of the European Myocardial Infarction Amiodarone Trial (EMIAT). Frequencies of peaks detected in 5-minute low-frequency HRV spectra were averaged to obtain the PLF index. PLF >0.1 Hz was the strongest univariate predictor of all-cause mortality associated with relative risk of 6.4 (95% CI, 3.9 to 10.6; P-12). In a multivariate Cox's regression model including clinical risk factors, mean RR interval, HRV index, low- and high-frequency HRV spectral power, and heart rate turbulence, PLF was the most powerful mortality predictor, with a relative risk of 4.6 (95% CI, 2.2 to 9.3; P=0.00003). Predictive power of PLF was blindly validated in the population of the Autonomic Tone and Reflexes After Myocardial Infarction (ATRAMI) trial. PLF ≥0.1 Hz was associated with univariate relative risk of 6.1 (95% CI, 2.9 to 12.9; P-5) for cardiac mortality or resuscitated cardiac arrest. In multivariate Cox's regression model including age, left ventricular ejection fraction, baroreflex sensitivity, mean RR interval, standard deviation of normal RR intervals, low- and high-frequency HRV spectral power, and heart rate turbulence, only left ventricular ejection fraction and PLF were significant predictors, with relative risks of 4.2 (95% CI, 1.5 to 11.7; P=0.007) and 3.6 (95% CI, 1.3 to 10.5; P=0.02), respectively. Conclusions-An innovative analysis of frequency-domain HRV, which characterizes the distribution of spectral power within the low-frequency band, is a potent and independent risk stratifier in postinfarction patients.

Original languageEnglish
Pages (from-to)1183-1190
Number of pages8
JournalCirculation
Volume110
Issue number10
DOIs
Publication statusPublished - Sep 7 2004

Keywords

  • Electrocardiography
  • Heart rate
  • Mortality
  • Myocardial infarction
  • Risk factors

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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