Baroreflex sensitivity but not microvolt T-wave alternans can predict major adverse cardiac events in ischemic heart failure
BACKGROUND: Major adverse cardiovascular events (MACE) constitutes the main cause of morbidity and mortality in ischemic heart failure (HF) patients. The prognostic value of the autonomic nervous system parameters and microvolt T-wave alternans (MTWA) in this issue has not been identified to date. The aim herein, was to assess the usefulness of the abovementioned parameters in the prediction of MACE in HF patients with left ventricular systolic dysfunction of ischemic origin.
METHODS: Baroreflex sensitivity (BRS), heart rate variability (HRV), MTWA and other well-known clinical parameters were analyzed in 188 ischemic HF outpatients with left ventricular ejection fraction (LVEF) ≤ 50%. During 34 (14-71) months of follow-up, 56 (30%) endpoints were noted.
RESULTS: Univariate Cox analyses revealed BRS (but not HRV), MTWA, age, New York Heart Association functional class III, LVEF, implantable cardioverter-defibrillator presence, use of diuretics and antiarrhythmic drugs, diabetes, and kidney insufficiency were defined as significant predictors of MACE. Pre-specified cut-off values for MACE occurrence for the aforementioned continuous parameters (age, LVEF, and BRS) were: ≥ 72 years, ≤ 33%, and ≤ 3 ms/mmHg, respectively. In a multivariate Cox analysis only BRS (HR 2.97, 95% CI 1.35-6.36, p < 0.006), and LVEF (HR 1.98, 95% CI 0.61-4.52, p < 0.038) maintained statistical significance in the prediction of MACE.
CONCLUSIONS: Baroreflex sensitivity and LVEF are independent of other well-known clinical parameters in the prediction of MACE in patients with HF of ischemic origin and LVEF up to 50%. BRS ≤ 3 ms/mmHg and LVEF ≤ 33% identified individuals with the highest probability of MACE during the follow-up period.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
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| Enthalten in: |
Cardiology journal - 29(2022), 6 vom: 01., Seite 1004-1012 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kaufmann, Damian K [VerfasserIn] |
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| Links: |
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| Themen: |
Autonomic nervous system |
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| Anmerkungen: |
Date Completed 22.12.2022 Date Revised 03.01.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.5603/CJ.a2020.0129 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM315718749 |
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| 100 | 1 | |a Kaufmann, Damian K |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Baroreflex sensitivity but not microvolt T-wave alternans can predict major adverse cardiac events in ischemic heart failure |
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| 500 | |a Date Revised 03.01.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Major adverse cardiovascular events (MACE) constitutes the main cause of morbidity and mortality in ischemic heart failure (HF) patients. The prognostic value of the autonomic nervous system parameters and microvolt T-wave alternans (MTWA) in this issue has not been identified to date. The aim herein, was to assess the usefulness of the abovementioned parameters in the prediction of MACE in HF patients with left ventricular systolic dysfunction of ischemic origin | ||
| 520 | |a METHODS: Baroreflex sensitivity (BRS), heart rate variability (HRV), MTWA and other well-known clinical parameters were analyzed in 188 ischemic HF outpatients with left ventricular ejection fraction (LVEF) ≤ 50%. During 34 (14-71) months of follow-up, 56 (30%) endpoints were noted | ||
| 520 | |a RESULTS: Univariate Cox analyses revealed BRS (but not HRV), MTWA, age, New York Heart Association functional class III, LVEF, implantable cardioverter-defibrillator presence, use of diuretics and antiarrhythmic drugs, diabetes, and kidney insufficiency were defined as significant predictors of MACE. Pre-specified cut-off values for MACE occurrence for the aforementioned continuous parameters (age, LVEF, and BRS) were: ≥ 72 years, ≤ 33%, and ≤ 3 ms/mmHg, respectively. In a multivariate Cox analysis only BRS (HR 2.97, 95% CI 1.35-6.36, p < 0.006), and LVEF (HR 1.98, 95% CI 0.61-4.52, p < 0.038) maintained statistical significance in the prediction of MACE | ||
| 520 | |a CONCLUSIONS: Baroreflex sensitivity and LVEF are independent of other well-known clinical parameters in the prediction of MACE in patients with HF of ischemic origin and LVEF up to 50%. BRS ≤ 3 ms/mmHg and LVEF ≤ 33% identified individuals with the highest probability of MACE during the follow-up period | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a autonomic nervous system | |
| 650 | 4 | |a baroreflex sensitivity | |
| 650 | 4 | |a heart failure | |
| 650 | 4 | |a heart rate variability | |
| 650 | 4 | |a ischemic cardiomyopathy | |
| 650 | 4 | |a left ventricular dysfunction | |
| 650 | 4 | |a microvolt T-wave alternans | |
| 700 | 1 | |a Raczak, Grzegorz |e verfasserin |4 aut | |
| 700 | 1 | |a Szwoch, Małgorzata |e verfasserin |4 aut | |
| 700 | 1 | |a Wabich, Elżbieta |e verfasserin |4 aut | |
| 700 | 1 | |a Świątczak, Michał |e verfasserin |4 aut | |
| 700 | 1 | |a Daniłowicz-Szymanowicz, Ludmiła |e verfasserin |4 aut | |
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