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Postextrasystolic blood pressure potentiation predicts poor outcome of cardiac patients.

dc.contributor.authorSinnecker, Daniel
dc.contributor.authorDirschinger, Ralf J.
dc.contributor.authorBarthel, Petra
dc.contributor.authorMüller, Alexander
dc.contributor.authorMorley-Davies, Adrian
dc.contributor.authorHapfelmeier, Alexander
dc.contributor.authorDommasch, Michael
dc.contributor.authorHuster, Katharina M.
dc.contributor.authorHasenfuss, Gerd
dc.contributor.authorLaugwitz, Karl-Ludwig
dc.contributor.authorMalik, Marek
dc.contributor.authorSchmidt, Georg
dc.date.accessioned2015-06-10T13:17:19Z
dc.date.available2015-06-10T13:17:19Z
dc.date.issued2014-06-01
dc.identifier.citationSinnecker, Daniel; Dirschinger, Ralf J; Barthel, Petra; Müller, Alexander; Morley-Davies, Adrian; Hapfelmeier, Alexander; Dommasch, Michael; Huster, Katharina M; Hasenfuss, Gerd; Laugwitz, Karl-Ludwig; Malik, Marek; Schmidt, Georg (2014): Postextrasystolic blood pressure potentiation predicts poor outcome of cardiac patients. - Journal of the American Heart Association, Vol. 3, Nr. 3, p. e000857
dc.relation.ISSN2047-9980
dc.identifier.urihttp://resolver.sub.uni-goettingen.de/purl?gs-1/11873
dc.description.abstractBACKGROUND: Postextrasystolic blood pressure potentiation (PESP), the pulse wave augmentation after an extrasystolic beat, is typically enhanced in heart failure (HF) patients. This study prospectively tested the association of PESP and mortality in cardiac patients. METHODS AND RESULTS: Consecutive patients (n=941; mean age, 61 years; 19% female) presenting with acute myocardial infarction were enrolled between May 2000 and March 2005 and followed up until August 2010. The main study outcome was 5-year all-cause mortality. Patients underwent noninvasive 30-minute recordings of ECG and continuous blood pressure. PESP presence was based on the ratio between the first postectopic pulse wave amplitude and the mean of the subsequent 9 pulse wave amplitudes. A ratio above 1 was prospectively defined as PESP present. Ventricular premature complexes (VPCs) suitable for PESP quantification were present in recordings of 220 patients. PESP was present in 62 of these patients. Patients without suitable VPCs were classified as PESP absent.During the follow-up, 72 patients died. Among the 220 patients in whom PESP was measurable, 27 died. Under univariable analysis, PESP was a significant predictor of death (P<0.001) as were GRACE score (P<0.001), left ventricular ejection fraction (LVEF) (P<0.001), and the number of recorded VPCs (P<0.001). Under multivariable analysis, PESP (P<0.001), GRACE score (P<0.001), and LVEF (P=0.001) were independently associated with outcome. The combination of PESP presence and LVEF ≤ 35% identified a subgroup of patients with a particularly high mortality of 46.7%. Separate validation reproduced the finding in an unrelated population of 146 HF patients. CONCLUSIONS: PESP, which likely reflects abnormalities of myocardial calcium cycling, predicts the mortality risk in postinfarction patients. CLINICAL TRIAL REGISTRATION URL: ClinicalTrials.gov. Unique identifier: NCT00196274.
dc.languageeng
dc.language.isoeng
dc.rightsopenAccess
dc.rights.urihttps://creativecommons.org/licenses/by-nc/3.0/
dc.subjectcalcium cycling; myocardial infarction; risk assessment
dc.subject.meshAged
dc.subject.meshBlood Pressure
dc.subject.meshCardiac Complexes, Premature
dc.subject.meshElectrocardiography
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshMyocardial Infarction
dc.subject.meshProspective Studies
dc.subject.meshRisk Factors
dc.subject.meshStroke Volume
dc.subject.meshVentricular Premature Complexes
dc.titlePostextrasystolic blood pressure potentiation predicts poor outcome of cardiac patients.
dc.typejournalArticle
dc.identifier.doi10.1161/JAHA.114.000857
dc.type.versionpublishedVersion
dc.identifier.fs607905
dc.bibliographicCitation.volume3
dc.bibliographicCitation.issue3
dc.bibliographicCitation.firstPage1
dc.bibliographicCitation.lastPage10
dc.type.subtypejournalArticle
dc.identifier.pmid24895163
dc.bibliographicCitation.articlenumbere000857
dc.description.statuspeerReviewed
dc.bibliographicCitation.journalJournal of the American Heart Association


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