Heart rate turbulence assessed through ergometry after myocardial infarction: a feasibility study (original) (raw)

Abstract

INTRODUCTION Coronary artery disease is a condition characterized by increased atherosclerotic plaque in the epicardial arteries and is associated with high morbidity and mortality. Coronary artery disease accounts for nearly 360,000 events per year 1 in the United States, among which most occur in the hospital setting, and many events evolve to death before the patients are transported to the emergency room. 1 In the first six months of 2019, 137,713 hospitalizations due to coronary artery disease were recorded in Brazil, and 5.8% culminated in inhospital death. 2 Some clinical factors and complementary test markers help in the prognostic evaluation of coronary artery disease. Among these, the following can be highlighted: advanced age, male gender, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking and myocardial dysfunction. 3,4 However, the impairment of cardiac vagal activity over the first year after a diagnosis of myocardial infarction has been made is also a good indicator for identifying the development of heart disease and sudden death over the short and medium term. 5-7 Analysis on the behavior of heart rate turbulence (HRT), obtained through 24-hour Holter monitoring, is one of the easiest and most efficient means for assessing cardiac autonomic dysfunction. 8 Sade et al. 8 found that HRT was similar to the ejection fraction in an assessment of the prognosis of 128 individuals post-infarction. On the other hand, the Innovative Stratification of Arrythmic Risk-Heart Rate Turbulence (ISAR-HRT) 9 study showed that altered HRT parameters increased the risk of death almost sixfold, in a prospective analysis on 1,500 survivors of myocardial infarction analyzed over a 22-month period. This risk exceeded the risks attributed to severe ventricular dysfunction, diabetes mellitus and age over 65 years.

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  18. Authors' contributions: Gomes RAF: conceptualization (equal), data curation (equal), formal analysis (equal), investigation (equal), methodology (equal) and writing-original draft (equal); Sobral-Filho DC: methodology (equal), supervision (equal), validation (equal) and writing-review and editing (equal) Acknowledgements: Fátima Monteiro and Afonso Albuquerque, for -Brasil (CAPES), under finance code 001 Conflicts of interests: None Date of first submission: October 29, 2021 Last received: December 22, 2021
  19. Accepted: January 27, 2022 Address for correspondence: Rafael Alessandro Ferreira Gomes Departamento de Cardiologia, Universidade de Pernambuco (UPE) R. dos Palmares, s/n o Santo Amaro -Recife (PE) -Brasil CEP 50100-010