Daniel Sinnecker1, Michael Dommasch1, Alexander Steger1, Anna Berkefeld1, Petra Hoppmann1, Alexander Müller1, Josef Gebhardt1, Petra Barthel1, Katerina Hnatkova2, Katharina M Huster1, Karl-Ludwig Laugwitz3, Marek Malik2, Georg Schmidt4. 1. 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 2. Saint Paul's Cardiac Electrophysiology, University of London and Imperial College, London, London, United Kingdom. 3. 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. 4. 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. Electronic address: gschmidt@tum.de.
Abstract
BACKGROUND: Respiratory sinus arrhythmia (RSA), a measure of cardiac vagal modulation, provides cardiac risk stratification information. RSA can be quantified from Holter recordings as the high-frequency component of heart rate variability or as the variability of RR intervals in individual respiratory cycles. However, as a risk predictor, RSA is neither exceptionally sensitive nor specific. OBJECTIVES: This study aimed to improve RSA determination by quantifying the amount of sinus arrhythmia related to expiration (expiration-triggered sinus arrhythmia [ETA]) from short-term recordings of electrocardiogram and respiratory chest excursions, and investigated the predictive power of ETA in survivors of acute myocardial infarction. METHODS: Survivors of acute myocardial infarction (N = 941) underwent 30-min recordings of electrocardiogram and respiratory chest excursions. ETA was quantified as the RR interval change associated with expiration by phase-rectified signal averaging. Primary outcome was 5-year all-cause mortality. Univariable and multivariable Cox regression was used to investigate the association of ETA with mortality. RESULTS: ETA was a strong predictor of mortality, both in univariable and multivariable analysis. In a multivariable model including respiratory rate, left ventricular ejection fraction, diabetes mellitus, and GRACE score, ETA ≤0.19 ms was associated with a hazard ratio of 3.41 (95% confidence interval: 1.10 to 5.89, p < 0.0001). In patient subgroups defined by abnormal left ventricular ejection fraction, increased respiratory rate, high GRACE score, or presence of diabetes mellitus, patients were classified as high or low risk on the basis of ETA. CONCLUSIONS: Expiration-triggered sinus arrhythmia (ETA) is a potent and independent post-infarction risk marker.
BACKGROUND:Respiratory sinus arrhythmia (RSA), a measure of cardiac vagal modulation, provides cardiac risk stratification information. RSA can be quantified from Holter recordings as the high-frequency component of heart rate variability or as the variability of RR intervals in individual respiratory cycles. However, as a risk predictor, RSA is neither exceptionally sensitive nor specific. OBJECTIVES: This study aimed to improve RSA determination by quantifying the amount of sinus arrhythmia related to expiration (expiration-triggered sinus arrhythmia [ETA]) from short-term recordings of electrocardiogram and respiratory chest excursions, and investigated the predictive power of ETA in survivors of acute myocardial infarction. METHODS: Survivors of acute myocardial infarction (N = 941) underwent 30-min recordings of electrocardiogram and respiratory chest excursions. ETA was quantified as the RR interval change associated with expiration by phase-rectified signal averaging. Primary outcome was 5-year all-cause mortality. Univariable and multivariable Cox regression was used to investigate the association of ETA with mortality. RESULTS: ETA was a strong predictor of mortality, both in univariable and multivariable analysis. In a multivariable model including respiratory rate, left ventricular ejection fraction, diabetes mellitus, and GRACE score, ETA ≤0.19 ms was associated with a hazard ratio of 3.41 (95% confidence interval: 1.10 to 5.89, p < 0.0001). In patient subgroups defined by abnormal left ventricular ejection fraction, increased respiratory rate, high GRACE score, or presence of diabetes mellitus, patients were classified as high or low risk on the basis of ETA. CONCLUSIONS: Expiration-triggered sinus arrhythmia (ETA) is a potent and independent post-infarction risk marker.
Authors: Christiane Jungen; Fares-Alexander Alken; Christian Eickholt; Katharina Scherschel; Pawel Kuklik; Niklas Klatt; Jana Schwarzl; Julia Moser; Mario Jularic; Ruken Oezge Akbulak; Benjamin Schaeffer; Stephan Willems; Christian Meyer Journal: Arch Med Sci Date: 2019-03-25 Impact factor: 3.318
Authors: Alexander Steger; Alexander Müller; Petra Barthel; Michael Dommasch; Katharina Maria Huster; Katerina Hnatkova; Daniel Sinnecker; Alexander Hapfelmeier; Marek Malik; Georg Schmidt Journal: Front Physiol Date: 2019-02-04 Impact factor: 4.566
Authors: Xu Cao; Alexander Müller; Ralf J Dirschinger; Michael Dommasch; Alexander Steger; Petra Barthel; Karl-Ludwig Laugwitz; Georg Schmidt; Daniel Sinnecker Journal: Front Physiol Date: 2020-01-15 Impact factor: 4.566
Authors: Alexander Steger; Michael Dommasch; Alexander Müller; Petra Barthel; Daniel Sinnecker; Larissa Wieg; Alexander Hapfelmeier; Helene Hildegard Heidegger; Katharina Maria Huster; Eimo Martens; Karl-Ludwig Laugwitz; Georg Schmidt; Ralf Dirschinger Journal: Sci Rep Date: 2022-04-12 Impact factor: 4.379
Authors: Romy Ubrich; Petra Barthel; Bernhard Haller; Katerina Hnatkova; Katharina Maria Huster; Alexander Steger; Alexander Müller; Marek Malik; Georg Schmidt Journal: PLoS One Date: 2017-10-20 Impact factor: 3.240
Authors: Markus Zabel; Christian Sticherling; Rik Willems; Andrzej Lubinski; Axel Bauer; Leonard Bergau; Frieder Braunschweig; Josep Brugada; Sandro Brusich; David Conen; Iwona Cygankiewicz; Panagiota Flevari; Milos Taborsky; Jim Hansen; Gerd Hasenfuß; Robert Hatala; Heikki V Huikuri; Svetoslav Iovev; Stefan Kääb; Gabriela Kaliska; Jaroslaw D Kasprzak; Lars Lüthje; Marek Malik; Tomas Novotny; Nikola Pavlović; Georg Schmidt; Tchavdar Shalganov; Rajeeva Sritharan; Simon Schlögl; Janko Szavits Nossan; Vassil Traykov; Anton E Tuinenburg; Vasil Velchev; Marc A Vos; Stefan N Willich; Tim Friede; Jesper Hastrup Svendsen; Béla Merkely Journal: ESC Heart Fail Date: 2018-10-09