Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction
The LancetPublished 1 February 1998Open access
Maria Teresa La Rovere, J. Thomas Bigger, Gregory M. Marcus, Andrea Mortara, Peter J. Schwartz
Citations3,092
SJR quartileQ1
SJR score12.11
SNIP22.72
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TL;DR
ATRAMI provides clinical evidence that after myocardial infarction the analysis of vagal reflexes has significant prognostic value independently of LVEF and of ventricular arrhythmias and that it significantly adds to the prognostic value of heart-rate variability.
Abstract
ATRAMI provides clinical evidence that after myocardial infarction the analysis of vagal reflexes has significant prognostic value independently of LVEF and of ventricular arrhythmias and that it significantly adds to the prognostic value of heart-rate variability.
Keywords
MedicineEngineering
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In this country, ventricular fibrillation is the likely mechanism for sudden death and the leading cause of fatality among patients with coronary heart disease.
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689 Citations1992Peter J. Schwartz, Maria Teresa La Rovere +1 more
A definitive answer on the role that the analysis of markers of cardiac vagal activity may play in risk stratification of patients with coronary artery disease should be provided by Autonomic Tone and Reflexes After Myocardial Infarction (ATRAMI), an ongoing prospective study.
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636 Citations1988Maria Teresa La Rovere, Giorgina Specchia +2 more
BRS was assessed by calculating the regression line relating phenylephrine-induced increases in systolic blood pressure to the attendant changes in the RR interval and found that a reduced BRS primarily reflects an impairment in the vagal efferent component of the baroreceptor reflexes.
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CirculationAutonomic mechanisms in ventricular fibrillation induced by myocardial ischemia during exercise in dogs with healed myocardial infarction. An experimental preparation for sudden cardiac death.
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The ischemia-induced reduction in heart rate despite continuation of exercise suggests the presence in the dogs that survived of active vagal reflexes that may have played an important role in the maintenance of cardiac electrical stability.
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It is concluded that anterior wall MI significantly attenuates the baroreceptor reflex control of heart rate and that analysis of the heart rate response to arterial pressure increases allows identification of subgroups of dogs at higher risk for ventricular fibrillation.
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It is shown that approximately 36% of patients recovering from acute myocardial infarction presented with less than one premature ventricular beat per hour in Holter recordings obtained before discharge from the hospital, whereas almost 20%o of patients showed frequent (more than 10 prematurely ventricular beats per hour) ventricular arrhythmias.
CirculationThe effects of daily exercise on susceptibility to sudden cardiac death.
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It is concluded that daily exercise prevents VF induced by acute myocardial ischemia in a subpopulation of dogs that were previously identified as susceptible to sudden cardiac death.
CirculationExercise training confers anticipatory protection from sudden death during acute myocardial ischemia.
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Anatomy and Central Integration Biochemistry of the Vagal Control System Physiological Effects on the Heart Role in Cardiac Reflexes and Methods for Clinical Assessment of Vagal Activity Role in Experimental and Clinical Arrhythmias are presented.
HeartPrognostic value of baroreflex sensitivity testing after acute myocardial infarction.
271 Citations1992T Farrell, O Odemuyiwa +5 more
Disordered autonomic function as measured by depressed baroreflex sensitivity or reduced heart rate variability was associated with an increase incidence of arrhythmic events in post-infarction patients andBaroreflex testing can be safely performed in the immediate post-Infarction period.
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The amount of RR variability and its slower fluctuations largely depend on physical activity, regardless of its regular or irregular occurrence, and attempts to predict cardiovascular prognosis should therefore take account of the confounding effect of physical activity.
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180 Citations1989J. Thomas Bigger, Maria Teresa La Rovere +5 more
Baroreflex sensitivity and tonic vagal activity reflected by Holter variables were reduced more in patients with inferior myocardial infarction than in those with anterior infarctions, indicating that the Holter measures did not accurately predict baroreflexensitivity.
CirculationThe effects of daily exercise on susceptibility to sudden cardiac death.
178 Citations1984G EBillman, P JSchwartz +1 more
Journal of the American College of CardiologyBaroreflex Sensitivity and Its Evolution During the First Year After Myocardial Infarction
163 Citations1988Peter J. Schwartz, Antonio Zaza +4 more
Assessing the potential existence of differences in baroreflex sensitivity between men with and without myocardial infarction and the time course during the 1st year after infarctions indicates that barore Flex sensitivity is lower in a proportion of postinfarction patients than in control subjects.
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112 Citations1991Gaetano Maria De Ferrari, Emilio Vanoli +4 more
This study indicates that approximately 75% of animals resistant to ventricular fibrillation are characterized by weak sympathetic reflexes in response to acute myocardial ischemia, and in the remaining 25% powerful vagal reflexes counteract concomitant reflex sympathetic hyperactivity, decrease heart rate, and are essential for survival.
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The presence of an open IRA is associated with higher baroreflex sensitivity, and this effect is largely independent of limitation of infarct size by IRA patency, which offers new insights into the mechanisms by which coronary artery patency may affect cardiac electrical stability and survival.
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The article focuses largely on the clinical studies relating BRS and risk of cardiac mortality and also discusses the several attempts to modify this marker of reflex vagal activation.
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