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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Prognosis of In-Hospital Myocardial Infarction Course for Diabetic and Nondiabetic Patients Using a Noninvasive Evaluation of Hemodynamics and Heart Rate Variability

1
Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences
2
Department of Physics, Mathematics, and Biophysics, Medical Academy, Lithuanian University of Health Sciences
3
Clinic of Heart and Vascular Diseases, Vilnius University, Lithuania
*
Author to whom correspondence should be addressed.
Medicina 2013, 49(6), 42; https://doi.org/10.3390/medicina49060042
Received: 20 March 2013 / Accepted: 30 May 2013 / Published: 4 June 2013
Background and Objective. The objective of our study was to investigate whether the combination of markers of heart rate variability (HRV) and impedance cardiography (ICG) help evaluate the risk of in-hospital death, ventricular arrhythmia, or complicated course secondary to myocardial infarction (STEMI) and to clarify whether combined analysis of HRV and ICG improve prognosis of STEMI, comparing 3 groups: 1) diabetic, 2) nondiabetic, and 3) diabetes-unselected patients.
Material and Methods. The parameters reflecting heart rate variability and central hemodynamics were estimated from a 24-hour synchronic electrocardiogram and thoracic impedance signal recordings in 232 patients (67 diabetic) on the third day after myocardial infarction. Logistic regression analysis was used to determine the predictors of selected outcomes. Different prognostic models were compared with the receiver operating characteristic curve analysis.
Results. The model consisting of low- and high-frequency power ratio (LF/HF) and cardiac output (CO) was elaborated for the prognosis of in-hospital death in the group 3 (odds ratios [ORs] were 9.74 and 4.85, respectively). Very low-frequency power (VLF), cardiac index (CIN), and cardiac power output (CPO) were the predictors of ventricular arrhythmia in the group 2 (ORs of 1.005, 5.09, and 66.7, respectively) and the group 3 (ORs of 1.004, 3.84, and 37.04, respectively). The predictors of the complicated in-hospital course in the group 1 were the baseline width of the minimum square difference triangular interpolation of the highest peak of the histogram of all NN intervals (TINN) and stroke volume (SV) (ORs of 1.006, and 1.009, respectively); in the group 2, the mean of the standard deviations of all NN intervals for all 5-minute segments of the recording (SDNN index) and CPO (ORs of 1.06 and 2.44, respectively); and in the group 3, SDNN index, VLF, LF/HF, CIN (ORs of 1.04, 1.004, 2.3, and 3.49, respectively).
Conclusions
. The patients with decreased HRV and low estimates of central hemodynamics evaluated by ICG are at an increased risk of the adverse in-hospital course of STEMI. The combined analysis of HRV and ICG hemodynamic estimates contributes to the risk assessment of the complicated in-hospital course of STEMI, in-hospital hemodynamically significant ventricular arrhythmia, and in-hospital death secondary to STEMI. The in-hospital prognostic value of the combined estimates of HRV and ICG is lower in the STEMI patients with diabetes mellitus as compared with the nondiabetic patients.
Keywords: myocardial infarction; diabetes mellitus; prognosis; mortality; ventricular arrhythmia; impedance cardiography; heart rate variability myocardial infarction; diabetes mellitus; prognosis; mortality; ventricular arrhythmia; impedance cardiography; heart rate variability
MDPI and ACS Style

Ablonskytė-Dūdonienė, R.; Bakšytė, G.; Čeponienė, I.; Kriščiukaitis, A.; Drėgūnas, K.; Ereminienė, E. Prognosis of In-Hospital Myocardial Infarction Course for Diabetic and Nondiabetic Patients Using a Noninvasive Evaluation of Hemodynamics and Heart Rate Variability. Medicina 2013, 49, 42.

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