Prognostic value of baroreflex sensitivity testing after acute myocardial infarction.

T G Farrell, O Odemuyiwa, Y Bashir, T R Cripps, M Malik, D E Ward, A J Camm

Department of Cardiological Sciences, St George's Hospital Medical School, London.

BACKGROUND--Disturbances of autonomic function are recognised in both the acute and convalescent phases of myocardial infarction. Recent studies have suggested that disordered autonomic function, particularly the loss of protective vagal reflexes, is associated with an increased incidence of arrhythmic deaths. The purpose of this study was to compare the value of differing prognostic indicators with measures of autonomic function and to assess the safety of arterial baroreflex testing early after infarction. METHODS--As part of a prospective trial of risk stratification in post-infarction patients arterial baroreflex sensitivity, heart rate variability, long term electrocardiographic recordings, exercise stress testing, and ejection fraction were recorded between days 7 and 10 in 122 patients with acute myocardial infarction. RESULTS--During a one year follow up period there were 10 arrhythmic events. Baroreflex sensitivity was appreciably reduced in these patients suffering arrhythmic events (1.73 SD (1.49) v 7.83 (4.5) ms/mm hg, 95% confidence interval (CI) 4.8 to 7.3, p = 0.0001). Significant correlations were noted with age (r = -0.68, p less than 0.001) but not left ventricular function. When baroreflex sensitivity was adjusted for the effects of age and ventricular function baroreflex sensitivity was still considerably reduced in the arrhythmic group (2.1 v 7.57 ms/mm Hg, p less than 0.0001). Depressed baroreflex sensitivity carried the highest relative risk for arrhythmic events (23.1, 95% CI 7.7 to 69.2) and was superior to other prognostic variables including left ventricular function (10.4, 95% CI 3.3 to 32.6) and heart rate variability (10.1, 95% CI 5.6 to 18.1). No major complications were noted with baroreflex testing and in particular no patients developed ischaemic or arrhythmic symptoms during the procedure. CONCLUSIONS--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. Baroreflex testing can be safely performed in the immediate post-infarction period.

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• Murdoch, D.R., McMurray, J.J.V. (1999). Cardiac cachexia--lean and mean. Eur Heart J 20: 1609-1611  
• Rostagno, C., Felici, M., Caciolli, S., Olivo, G., Comeglio, M., Galanti, G., Serneri, G. G. N. (1999). Decreased Baroreflex Sensitivity Assessed from Phase IV of Valsalva Maneuver in Mild Congestive Heart Failure. ANGIOLOGY 50: 655-664 [Abstract]  
• Takahashi, N., Nakagawa, M., Saikawa, T., Ooie, T., Akimitsu, T., Kaneda, K., Hara, M., Iwao, T., Yonemochi, H., Ito, M., Sakata, T. (1999). Noninvasive assessment of the cardiac baroreflex: Response to downward tilting and comparison with the phenylephrine method. J Am Coll Cardiol 34: 211-215 [Abstract] [Full Text]  
• Van Vliet, B. N, Chafe, L. L, Montani, J.-P. (1999). Contribution of baroreceptors and chemoreceptors to ventricular hypertrophy produced by sino-aortic denervation in rats. J. Physiol. 516: 885-895 [Abstract] [Full Text]  
• Chiou, C.-W., Zipes, D. P. (1998). Selective Vagal Denervation of the Atria Eliminates Heart Rate Variability and Baroreflex Sensitivity While Preserving Ventricular Innervation. Circulation 98: 360-368 [Abstract] [Full Text]  
• Pitzalis, M. V., Mastropasqua, F., Passantino, A., Massari, F., Ligurgo, L., Forleo, C., Balducci, C., Lombardi, F., Rizzon, P. (1998). Comparison Between Noninvasive Indices of Baroreceptor Sensitivity and the Phenylephrine Method in Post–Myocardial Infarction Patients. Circulation 97: 1362-1367 [Abstract] [Full Text]  
• Laitinen, T., Hartikainen, J., Vanninen, E., Niskanen, L., Geelen, G., Lansimies, E. (1998). Age and gender dependency of baroreflex sensitivity in healthy subjects. J. Appl. Physiol. 84: 576-583 [Abstract] [Full Text]  
• Jensen-Urstad, K, Bouvier, F, Saltin, B, Jensen-Urstad, M (1998). High prevalence of arrhythmias in elderly male athletes with a lifelong history of regular strenuous exercise. Heart 79: 161-164 [Abstract] [Full Text]  
• Mortara, A., La Rovere, M. T., Pinna, G. D., Prpa, A., Maestri, R., Febo, O., Pozzoli, M., Opasich, C., Tavazzi, L. (1997). Arterial Baroreflex Modulation of Heart Rate in Chronic Heart Failure : Clinical and Hemodynamic Correlates and Prognostic Implications. Circulation 96: 3450-3458 [Abstract] [Full Text]  
• Arrowood, J. A., Minisi, A. J., Goudreau, E., Davis, A. B., King, A. L. (1997). Absence of Parasympathetic Control of Heart Rate After Human Orthotopic Cardiac Transplantation. Circulation 96: 3492-3498 [Abstract] [Full Text]  
• Kruger, C., Kalenka, A., Haunstetter, A., Schweizer, M., Maier, C., Ruhle, U., Ehmke, H., Kubler, W., Haass, M. (1997). Baroreflex sensitivity and heart rate variability in conscious rats with myocardial infarction. Am. J. Physiol. Heart Circ. Physiol. 273: H2240-H2247 [Abstract] [Full Text]  
• Robinson, T. G., James, M., Youde, J., Panerai, R., Potter, J. (1997). Cardiac Baroreceptor Sensitivity Is Impaired After Acute Stroke. Stroke 28: 1671-1676 [Abstract] [Full Text]  
• Hirschl, M., Kundi, M., Blazek, G. (1996). Five-Year Follow-up of Patients After Thromboendarterectomy of the Internal Carotid Artery: Relevance of Baroreceptor Sensitivity. Stroke 27: 1167-1172 [Abstract] [Full Text]  
• Mortara, A., Specchia, G., La Rovere, M. T., Bigger, J. T. Jr, Marcus, F. I., Camm, J. A., Hohnloser, S. H., Nohara, R., Schwartz, P. J. (1996). Patency of Infarct-Related Artery : Effect of Restoration of Anterograde Flow on Vagal Reflexes. Circulation 93: 1114-1122 [Abstract] [Full Text]  
• Townend, J. N., Al-Ani, M., West, J. N., Littler, W. A., Coote, J. H. (1995). Modulation of Cardiac Autonomic Control in Humans by Angiotensin II. Hypertension 25: 1270-1275 [Abstract] [Full Text]  
• Hull, S. S. Jr, Vanoli, E., Adamson, P. B., De Ferrari, G. M., Foreman, R. D., Schwartz, P. J. (1995). Do Increases in Markers of Vagal Activity Imply Protection From Sudden Death? : The Case of Scopolamine. Circulation 91: 2516-2519 [Abstract] [Full Text]