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European Heart Journal 1997 18(1):78-83;
Copyright © 1997 by the European Society of Cardiology.
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© 1997 The European Society of Cardiology

Influence of residual ischaemia on heart rate variability after myocardial infarction

D. Cerati*, F. Nador{dagger}, R. Maestri{ddagger}, M. Mantica{dagger}, A. Binda{dagger}, S. Perlini{dagger} and E. Vanoli§,*,

*Istituto Clinica Medica Generale e Terapia Medica Universita di Milano Montescano, Italy
{dagger}Divisione di Cardiologia IRCCS Ospedale Maggiore di Milano Montescano, Italy
{ddagger}Fondazione Clinica del Lavoro, Servizio di Bio-Ingegneria Centro Medico di Moniescano Montescano, Italy
§Dipartimento di Medicina Interna, Sezione di Cardiologia Universita di Pavia Montescano, Italy

revised 12 March 1996; accepted 20 March 1996.

Correspondence: Emilio Vanoli, MD, FESC, Centro Fisiologia Clinica e Ipertensione. Ospedale Maggiore. Via F Sforza 35, 20122 Milano, Italy

Abstract

Despite the growing evidence for the positive predictive value of depressed baroreflex sensitivity and/or reduced heart rate variability after myocardial infarction, the mechanisms involved in these autonomic alterations are not fully understood. Specifically, the possible influence of residual ischaemia has not been assessed.

To address this problem we studied the spectral analysis of heart rate variability in 21 patients with a first myocardial infarction in whom the only clinical correlate was the presence of residual ischaemia, as documented by the positive response to both an exercise stress test and an echocardiographic stress test. Data from these patients were compared with those obtained in a group of postmyocardial infarction patients similar for several risk factors, age, site of myocardial infarction, but without residual ischaemia. Patients positive for residual ischaemia had lower power in the whole spectrum (1146±158 vs 1631±159 ms2, P=0—032) as well as in the low and high frequency bands of heart rate variability. A nocturnal increase in high frequency was observed in those without residual ischaemia (from 167 ± 35 to 242 ± 51 ms2, +45%, P0·034), but not in those with residual ischaemia (from 111 ± 19 to 141 ± 29 ms2, +27%, ns).

Thus, residual ischaemia reduces heart rate variability after myocardial infarction. The autonomic effects of residual ischaemia probably contribute to its negative prognostic value after myocardial infarction.

Key Words: Myocardial ischaemia • autonomic nervous system • coronary artery disease


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F. Weber, H. Schneider, T. von Arnim, and W. Urbaszek
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Eur. Heart J., January 1, 1999; 20(1): 38 - 50.
[Abstract] [PDF]


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