CoChat
Sign Up
Cited by 3,120Heart Rate Variability and Autonomic ControlCardiac electrophysiology and arrhythmiasAcute Myocardial Infarction Research

Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction

Open access
Rovere, Maria Teresa La, Bigger, J Thomas, Marcus, Frank I, Mortara, Andrea, Schwartz, Peter J·1998·The Lancet
DOI 10.1016/s0140-6736(97)11144-8
Open this paper in CoChat — free account

Abstract

BACKGROUND: Experimental evidence suggests that autonomic markers such as heart-rate variability and baroreflex sensitivity (BRS) may contribute to postinfarction risk stratification. There are clinical data to support this concept for heart-rate variability. The main objective of the ATRAMI study was to provide prospective data on the additional and independent prognostic value for cardiac mortality of heart-rate variability and BRS in patients after myocardial infarction in whom left-ventricular ejection fraction (LVEF) and ventricular arrhythmias were known. METHODS: This multicentre international prospective study enrolled 1284 patients with a recent (<28 days) myocardial infarction. 24 h Holter recording was done to quantify heart-rate variability (measured as standard deviation of normal to normal RR intervals [SDNN]) and ventricular arrhythmias. BRS was calculated from measurement of the rate-pressure response to intravenous phenylephrine. FINDINGS: During 21 (SD 8) months of follow-up, the primary endpoint, cardiac mortality, included 44 cardiac deaths and five non-fatal cardiac arrests. Low values of either heart-rate variability (SDNN <70 ms) or BRS (<3.0 ms per mm Hg) carried a significant multivariate risk of cardiac mortality (3.2 [95% CI 1.42-7.36] and 2.8 [1.24-6.16], respectively). The association of low SDNN and BRS further increased risk; the 2-year mortality was 17% when both were below the cut-offs and 2% (p<0.0001) when both were well preserved (SDNN >105 ms, BRS >6.1 ms per mm Hg). The association of low SDNN or BRS with LVEF below 35% carried a relative risk of 6.7 (3.1-14.6) or 8.7 (4.3-17.6), respectively, compared with patients with LVEF above 35% and less compromised SDNN (> or = 70 ms) and BRS (> or = 3 ms per mm Hg). INTERPRETATION: 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.

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(97)11144-8

Cites

2 of 2 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Pronounced RSA is beneficial to circulation and improves wellbeing, whereas uneven or reduced RSA is a predictor of circulatory complications.

    “It is documented that pronounced RSA is beneficial to circulation (Bernardi et al., 1998, 2001a; Friedman and Coats, 2000) and improves wellbeing (Friedman and Coats, 2000), whereas uneven or reduced RSA is a predictor of circulatory complications (La Rovere et al., 1998).”

    From Music structure determines heart rate variability of singers (2013) · cites this paper as La Rovere et al., 1998

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Rovere, M. T. L., Bigger, J. T., Marcus, F. I., Mortara, A., & Schwartz, P. J.
Affiliations
  • Istituti Clinici Scientifici Maugeri (IT)
  • Columbia University Irving Medical Center (US)
  • University of Pavia (IT)
Corresponding author
Rovere, Maria Teresa La
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
1998-02
Volume
351
Issue
9101
Pages
478-484
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(97)11144-8
OpenAlex
W2145912168
Cited by
3,120
References
2
Citations by year
2026: 40 · 2025: 51 · 2024: 68 · 2023: 83 · 2022: 87 · 2021: 81 · 2020: 94 · 2019: 110 · 2018: 97 · 2017: 103 · 2016: 126 · 2015: 132 · 2014: 128 · 2013: 131 · 2012: 136
FWCI
70.80
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • National Institute for Health and Care Research
  • National Institutes of Health (5r01hl041552-04)
  • National Heart, Lung, and Blood Institute (HL-41552)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
baroreflex sensitivity, heart rate variability, myocardial infarction, cardiac mortality, risk stratification, autonomic function, vagal reflex, left ventricular ejection fraction, ventricular arrhythmias, phenylephrine, SDNN, prognostic factors, cardiac arrest, Holter monitoring, 24-hour ambulatory monitoring
MeSH terms
Aged, Arrhythmias, Cardiac, Female, Heart Rate, Humans, Male, Middle Aged, Myocardial Infarction, Phenylephrine, Predictive Value of Tests, Prognosis, Prospective Studies, Risk Factors, Stroke Volume, Electrocardiography, Ambulatory, Survival Analysis, Ventricular Function, Left, Death, Sudden, Cardiac, Baroreflex

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review