Predictive values of heart rate variability, deceleration and acceleration capacity of heart rate in post-infarction patients with LVEF ≥35

Abstract

Background and aims: The aim was to investigate the predictive values of heart rate variability, deceleration, and acceleration capacity of heart rate in sudden cardiac death in postinfarction patients with left ventricular ejection fraction (LVEF) ≥ 35%.

Methods: We enrolled 138 acute myocardial infarction patients (MI) randomly in sinus rhythm with LVEF ≥ 35% after myocardial infarction. Data on heart rate variability, deceleration runs, deceleration, and acceleration capacity were obtained from 24h-dynamic electrocardiogram recordings. Clinical characteristics, medications, and echocardiography data were noted. The endpoints were sudden cardiac arrhythmias (SCA), including malignant arrhythmias in the hospital and viewed sudden death out of the hospital. Relationships between autonomic parameters and endpoints were evaluated.

Results: During follow-up for over 24 months in MI patients, 10 patients occurred sudden cardiac arrhythmias. Subjects with SCA showed lower levels of SDNN (p = .018), TP (p = .007), VLF (p < .001), DC (p < .001), and low-risk DRs (p < .001) than those without SCA. A low SDNN level (HR: 8.888, p = .006), low VLF level (HR: 14.699, p = .016), low DC level (HR: 4.430, p = .045), and higher risk DRs (HR: 3.81, p = .040) were identified as independent risk factors of SCA for postinfarction patients with LVEF ≥ 35%. The area under the ROC curve (AUC) of SDNN, VLF, and DC for identification of SCA were, respectively, 0.724 (p = .019), 0.807 (p < .001), and 0.804 (p = .002). SDNN, VLF, and DC combined assessment area under the ROC curve were 0.828 (p < .001).

Conclusion: Decreased SDNN, VLF, DC, and abnormal DRs are independently associated with increased risks of sudden cardiac arrhythmias in post-MI patients with LVEF ≥ 35%. Combined SDNN, VLF, and DC may help identify a high-risk group of malignant arrhythmias in postinfarction patients.

Keywords: autonomic function; heart rate variability; myocardial infarction; sudden death.