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Baroreflex sensitivity but not microvolt T-wave alternans can predict major adverse cardiac events in ischemic heart failure

Damian K. Kaufmann, Grzegorz Raczak, Małgorzata Szwoch, Elżbieta Wabich, Michał Świątczak, Ludmiła Daniłowicz-Szymanowicz
DOI: 10.5603/CJ.a2020.0129
·
Pubmed: 33001423

open access

Ahead of print
Original articles
Published online: 2020-09-28

Abstract

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 (ANS) 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 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: BRS 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.

Abstract

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 (ANS) 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 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: BRS 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.

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Keywords

autonomic nervous system, baroreflex sensitivity, heart rate variability, microvolt T-wave alternans, heart failure, left ventricular dysfunction, ischemic cardiomyopathy

About this article
Title

Baroreflex sensitivity but not microvolt T-wave alternans can predict major adverse cardiac events in ischemic heart failure

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-09-28

DOI

10.5603/CJ.a2020.0129

Pubmed

33001423

Keywords

autonomic nervous system
baroreflex sensitivity
heart rate variability
microvolt T-wave alternans
heart failure
left ventricular dysfunction
ischemic cardiomyopathy

Authors

Damian K. Kaufmann
Grzegorz Raczak
Małgorzata Szwoch
Elżbieta Wabich
Michał Świątczak
Ludmiła Daniłowicz-Szymanowicz

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