scholarly journals Comparison between invasive and non-invasive measurements of baroreflex sensitivity. Implications for studies on risk stratification after a myocardial infarction

2000 ◽  
Vol 21 (18) ◽  
pp. 1522-1529 ◽  
Author(s):  
G Pinna
2019 ◽  
Vol 40 (35) ◽  
pp. 2940-2949 ◽  
Author(s):  
Konstantinos A Gatzoulis ◽  
Dimitrios Tsiachris ◽  
Petros Arsenos ◽  
Christos-Konstantinos Antoniou ◽  
Polychronis Dilaveris ◽  
...  

Abstract Aims Sudden cardiac death (SCD) annual incidence is 0.6–1% in post-myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF)≥40%. No recommendations for implantable cardioverter-defibrillator (ICD) use exist in this population. Methods and results We introduced a combined non-invasive/invasive risk stratification approach in post-MI ischaemia-free patients, with LVEF ≥ 40%, in a multicentre, prospective, observational cohort study. Patients with at least one positive electrocardiographic non-invasive risk factor (NIRF): premature ventricular complexes, non-sustained ventricular tachycardia, late potentials, prolonged QTc, increased T-wave alternans, reduced heart rate variability, abnormal deceleration capacity with abnormal turbulence, were referred for programmed ventricular stimulation (PVS), with ICDs offered to those inducible. The primary endpoint was the occurrence of a major arrhythmic event (MAE), namely sustained ventricular tachycardia/fibrillation, appropriate ICD activation or SCD. We screened and included 575 consecutive patients (mean age 57 years, LVEF 50.8%). Of them, 204 (35.5%) had at least one positive NIRF. Forty-one of 152 patients undergoing PVS (27–7.1% of total sample) were inducible. Thirty-seven (90.2%) of them received an ICD. Mean follow-up was 32 months and no SCDs were observed, while 9 ICDs (1.57% of total screened population) were appropriately activated. None patient without NIRFs or with NIRFs but negative PVS met the primary endpoint. The algorithm yielded the following: sensitivity 100%, specificity 93.8%, positive predictive value 22%, and negative predictive value 100%. Conclusion The two-step approach of the PRESERVE EF study detects a subpopulation of post-MI patients with preserved LVEF at risk for MAEs that can be effectively addressed with an ICD. Clinicaltrials.gov identifier NCT02124018


2014 ◽  
Vol 47 (6) ◽  
pp. 874-880 ◽  
Author(s):  
Daniel Sinnecker ◽  
Katharina M. Huster ◽  
Alexander Müller ◽  
Michael Dommasch ◽  
Alexander Hapfelmeier ◽  
...  

EP Europace ◽  
2003 ◽  
Vol 4 (Supplement_2) ◽  
pp. B17-B17
Author(s):  
F. Roche ◽  
V. Pichot ◽  
A. Dacosta ◽  
M. Garet ◽  
K. Isaaz ◽  
...  

1998 ◽  
Vol 43 (3) ◽  
pp. 72-73 ◽  
Author(s):  
I. R. Mahy ◽  
G. S. Hillis ◽  
K. P. Jennings

The objective was to determine how patients are selected for invasive investigation after myocardial infarction in Scotland Cardiologists in Scotland were surveyed by postal questionnaire asking them to detail their approach to four sample clinical scenarios. Complete responses were obtained from 82% of those surveyed Substantial differences in practice were observed in the management of subjects with non-Q wave myocardial infarction. Of the cardiologists surveyed 40% would undertake coronary angiography irrespective of the results of non-invasive testing in a 45 year old patient, but only one would adopt the same policy in an otherwise fit 77 year old Only 44% would perform any investigations (beyond echocardiography) in the 77 year old A minority of respondents felt that their practice was influenced by resource limitation. Considerable variation continues to exist in the approach to risk stratification after myocardial infarction for some groups of patients. This variation may occur principally as a consequence of physician preference.


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