The speaker gave a good overview of the field of Heart Rate Variability (HRV). The main topics were physiological interpretation, methods of assessment and clinical utilization of HRV. The existence of HR turbulence predicts all-cause mortality and was found to be an important parameter. Another new parameter presented was the deceleration capacity, which is represents an important vagal control mechanism. Finally, it was stated that combination with BNP markers can increase the clinical usability.
Attention for the baroreflex sensitivity (BRS) goes back to the 70’s. A higher BRS is indicative of better survival in patients after myocardial infarction and in chronic heart failure patients. In her presentation, she demonstrated that BRS represents an important marker for risk stratification in CVD patients even on optimal treatment. Also, changes in BRS could be effective in tracking benefits of treatment. However, further prospective studies are needed to define decisional algorithms using BRS.
The first publications on T wave alternans date from around 1930 (on ventricular gradients). Prof. Malik stated that it is essential to be able to do research on the basis of short periods of ECG, for which T-wave analysis seems to be one of the best solutions. However, much is still unknown about the background of T-wave alternans. In multivariate models, the T-axis parameter appears to be better than the other T-wave parameters, as was shown by Kors in 1998 in the Lancet. A newer T-wave parameter is the TpPe interval. Surprisingly, survivors had a longer TpTe interval than non-survivors, which makes this parameter less useful. Also, the ventricular gradient appeared to be different in men and in women making the physiological background of this parameter unclear. Planar as well as spatial QRS-T angle appeared to be a good predictor of cardiac arrhythmia.
The speaker introduced three new short-term parameters for risk prediction after MI, based on ECG, respiration and arterial pressure. These parameters each provide independent information on the control of the circulatory system. Therefore, a scoring system based on these three parameters could be a powerful risk stratification tool, especially in patients with diminished EF. The overall conclusion is that the study of the autonomic nervous system appears to be still alive after three decades. However, good prospective studies are essential to demonstrate the efficacy in clinical practice but are currently lacking.
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