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PubMed2001

Is an increased intestinal permeability a valid predictor of relapse in Crohn disease?

BACKGROUND: An increased intestinal permeability (IP) may be a pathogenetic factor in Crohn disease (CD). Increases in IP could be an indicator of subclinical disease and precede clinical relapses. We examined whether an increased IP is a valid predictor of relapse in CD. METHODS: 27 patients with CD in remission (CDAI <150) and 22 healthy controls ingested 3.7 MBq of 51Cr-EDTA, 20 kBq of 14C-mannitol and 5 g of unlabelled mannitol in 100 ml of distilled water. The percent urine excretion (24 h) of labelled markers was determined. Patients were followed for 1 year or until relapse, defined as CDAI > 150 and > 50 from baseline. RESULTS: Median (25th-75th percentiles). The excretion of 51Cr-EDTA was 1.55% (1.13%-2.53%) for patients and 1.20% (1.11%-1.44%) for controls (P = 0.04). Three of 9 patients with a raised, and 6 of 18 patients with a normal, 51Cr-EDTA excretion relapsed (P = 1.00; Fisher's exact test). Thus, the specificity and sensitivity of the 51Cr-EDTA test as a predictor of relapse was 67% and 33%, respectively. The 51Cr-EDTA/14C-mannitol index was 0.060 (0.037-0.093) for patients and 0.045 (0.038-0.054) for controls (P = 0.06). Four of 12 patients with a raised, and 5 of 15 patients with a normal, index relapsed (P = 1.00; Fisher's exact test). Thus, the specificity and sensitivity of the index test as a predictor of relapse was 56% and 44%, respectively. For controls and patients in remission, who were tested twice, variability of and fluctuations in both the 51Cr-EDTA excretion and the index were greatest for patients. CONCLUSIONS: This study supports previous findings of an increased IP in patients with CD. Although fluctuations in the permeation of markers were pronounced in CD, neither the excretion of 51Cr-EDTA nor the 51Cr-EDTA/14C-mannitol index test were valid predictors of relapse in CD.

Adult↗

PubMed2001

Armed services vocational aptitude battery predictors of entry-level radiography students' success.

This study assessed the Armed Services Vocational Aptitude Battery (ASVAB) predictors of student success in the diagnostic imaging course at the Air Force's School of Health Care Sciences. Regression analyses provided two significant predictors (p < 0.05) of student success as identified by final grade. Those predictors were the mechanical and electronics scores on the ASVAB. Also, both scores were significantly different (p < 0.05) among those who passed, washed back (passed but required excess time), and disenrolled. Because a significant number of individuals take the ASVAB, entry-level radiography programs should consider using these predictors for admissions decisions.

Adult↗

PubMed2001

Exudative retinal detachment from malignant uveal melanoma: predictors and prognostic significance.

PURPOSE: To determine independent predictors of exudative retinal detachment (RD) in eyes with uveal melanoma and the significance of RD in melanoma-specific survival. METHODS: The extent of exudative RD was recorded retrospectively in a population-based cohort of 167 consecutive patients with eyes enucleated from 1972 through 1981 because of choroidal and ciliary body melanoma, representing all melanomas treated during that period. Histopathologic features including microvascular loops and networks, microvascular density (MVD), and tumor-infiltrating macrophages were determined. Clinical and histologic predictors of RD were modeled by multiple logistic regression with a split-sample, cross-validation design. Survival was assessed by Kaplan-Meier analysis and adjusted for the effect of competing predictors by Cox proportional hazards regression. RESULTS: Of 142 (85%) eyes with adequate data, 25% had no RD, 16% had subretinal fluid around the tumor, 43% had clinical RD in one to two quadrants, and 16% had RD in three to four quadrants. The RD was more extensive if the tumor was large (P < 0.0001) and had microvascular loops and networks (P = 0.0094) and less extensive if it involved ciliary body (P = 0.011). High MVD (P = 0.054) and ruptured Bruch's membrane (P = 0.065) tended to be associated with RD. Multiple logistic regression showed largest basal diameter (odds ratio [OR] 1.43 for each 1-mm change, P < 0.0001), microvascular loops and networks (OR 1.95 for each category change, P = 0.0095), and ciliary body involvement (OR 0.20, P = 0.0039) to be independently associated with RD; ruptured Bruch's membrane (P = 0.96) and MVD (P = 0.87) were not associated. Clinical RD predicted poor survival (0.59 vs. 0.37 at 20 years; P = 0.029) by Kaplan-Meier analysis, but not after adjusting for other prognostic factors by Cox regression (hazard ratio [HR] 1.00, P = 1.0). CONCLUSIONS: Tumor size, which may be a surrogate measure for total vascular content and decompensation of choriocapillaris and retinal pigment epithelium, is a strong predictor of exudative RD. Microvascular loops and networks are likewise associated with exudative RD. Exudative RD is not associated with survival after adjusting for tumor size and microvascular loops and networks.

Exudates and Transudates↗

PubMed2001

Do "conditions contributing to the death" clarify the predictors of infant mortality in Texas?

Predictors of infant mortality are usually based on the underlying causes reported on infant death certificates. Death certificates also contain space for "Other significant conditions contributing to the death but not resulting in the underlying cause." We investigated whether these "contributing conditions" might clarify the predictors of infant death in Texas or interventions that might reduce deaths from the underlying causes. A "multiple cause of death" file converted the underlying causes and contributing conditions associated with each infant death in 1996 into International Classification of Diseases codes. We ranked the major underlying causes, the conditions contributing to those causes, the conditions contributing to all infant deaths, and the effect of combining the underlying causes with contributing conditions to determine the main predictors of infant mortality. We found that extreme immaturity was the most common condition, causing or contributing to 604 of the 2081 deaths in 1996. We conclude that the underlying causes provide a misleading perception of the major predictors of infant death in Texas; combining them with the conditions contributing to those deaths provides a clearer picture. Given the powerful predictive value of preterm birth for infant mortality, the limited current ability to prevent preterm birth, and the cost of its complications, expanded efforts to improve understanding of its causal processes and develop preventive strategies should be top national and state priorities.

Cause of Death↗

PubMedDate not supplied

Clinical predictors of recurrence site after hepatectomy for metastatic colorectal cancer.

BACKGROUND/AIMS: Surgical resection of hepatic colorectal metastasis may produce long-term survival and cure; however, a significant proportion of patients will have intrahepatic and/or extrahepatic recurrence with a poor prognosis. The aim of this study was to define clinical predictors of recurrence site after hepatectomy in terms of stratifying patients for adequate adjuvant trials to improve the prognosis. METHODOLOGY: Clinical, pathologic, and outcome data for 70 consecutive patients undergoing hepatectomy for colorectal metastasis isolated to the liver were reviewed retrospectively, and all data were analyzed by the logistic multivariate regression model. RESULTS: Recurrence in the remnant liver was seen in 60% of patients, and recurrence in the lung was found in 34% of patients. Number of liver tumors was the only significant and independent predictor of recurrence in the remnant liver (P = 0.048). All patients with three or more tumors experienced recurrence. Location of liver tumors lying adjacent to the hepatic vein, which was confirmed by preoperative imaging techniques, was the only significant and independent predictor of recurrence in the lung (P = 0.020). CONCLUSIONS: Number and location of liver tumors would be the significant and independent clinical predictors of recurrence site after hepatectomy for metastatic colorectal cancer. This might be useful for justification and selection of effective adjuvant trials after surgery.

Colorectal Neoplasms↗

PubMed1975

Predictors of sudden cardiac death.

A search was made for predictors of sudden cardiac death (SCD) among 197 men, age 40 to 79, who had multiphasic health checkups and experienced SCD 2 days to 5 1/2 years later (mean 18.1 months). Two age-sex-race-matched control groups, one matched and one unmatched for standard coronary risk factors, have been compared to the cases. In this ambulatory population, SCD occurred largely in persons with prior diagnosed heart disease. Standard coronary risk factors were confirmed as predictors of SCD. Predictors among other laboratory and quantitative tests include chylous serum, uric acid, hemoglobin, leukocyte count, pulse rate, diminished lung volumes, and hearing loss. Some of these had predictive value independent of standard risk factors. Pain tolerance was not related to SCD or to death in, versus out of hospital. Most of these predictors were not related to terminal symptom duration; this suggests a relationship more to the underlying atherosclerotic process than to the terminal fatal mechanism.

Adult↗

PubMed2001

A pattern of long-term predictors of health ratings among older people.

The aim of our study was to examine the predictors of health ratings by applying a path analysis model to a set of data from 75-year-old men and women in a 5-year follow-up study. The study was part of the Evergreen project with the study group comprising all the eligible inhabitants of Jyväskylä, central Finland (N=382). The data were based on an interview and study center examinations focusing on different domains of health and functional capacity. Among the women, better health ratings at baseline, better functional ability and maximal working capacity, and a higher number of social contacts were important direct predictors of better health ratings at follow-up. Among the men, better health ratings at baseline, and depending on the model, higher physical activity or a lower number of chronic conditions and better functional ability were the most important direct predictors. The explanatory power of the path analysis models was 31-39% for men and 32% for women. In conclusion, health ratings reflect multiple dimensions of health and functioning. In addition to significant direct effects on health ratings, the predictors also have sequential effects running from life-style through functional performance and the activities of daily living to health ratings. The factors associated with health ratings differ to some extent by gender.

Aged↗

PubMed2002

Predictors of course completion for the U.S. Army pharmacy specialist course.

The purpose of this study was to determine predictors of successful completion of the U.S. Army Medical Department pharmacy specialist (91Q) training program. The sample consisted of 143 students from four course iterations, and only students enrolled in the course for the first time were included for analysis. The relationship between 16 predictor variables and successful completion was assessed. Five variables, the ranks of private (E1) and specialist (E4), cross-trainee status, gender, and Armed Services Vocational Aptitude Battery (ASVAB) general technical (GT) score, were found to be significant predictors using simple linear regression. Using hierarchical multiple linear regression analysis, three variables, service component, gender, and ASVAB GT score, were found to have a significant unique shared variance with success. The results of this study indicate that ASVAB GT scores are predictive of success (p < 0.01) in the 91Q training program. Using these predictors, the selection process may be modified to improve the likelihood of student success in the course.

Accreditation↗

PubMed2002

Predictors of inpatient mortality in 190 adult patients with tuberculous meningitis.

INTRODUCTION: Tuberculous meningitis (TBM), a tuberculous infection of the leptomeninges, carries significant morbidity and mortality. To date, little literature is available regarding TBM in Pakistan. METHODS: All adult patients with TBM admitted to a tertiary care teaching hospital in Karachi, were reviewed retrospectively. AIMS: To describe the demographic profile, clinical features, laboratory and radiological picture of these patients and to identify predictors of mortality. RESULTS: Among the 190 patients analyzed, majority (28%) were between 21-30 years of age. Fever (90%), impaired consciousness (63%) and nausea/vomiting (50%) were the most common presenting symptoms. Thirty four percent were categorized as clinical stage III. CSF cultures were positive in only 5%. Thirty seven percent had an associated lung pathology on a chest X-ray. Neuroimaging revealed meningeal enhancement in 27% and hydrocephalus in 23%. All patients were treated with antituberculous therapy; 79% received concomitant steroid therapy. Neurosurgical intervention was required in 13% and mechanical ventilation support in 12%. Overall mortality was 20% and neurological sequelae were seen in 42% of the survivors. Univariate analysis showed age greater than sixty years, clinical stage III and mechanical ventilation as predictors of mortality. The logistic regression model, however, revealed that stage III presentation was not an independent predictor. CONCLUSION: We continue to see late presentations of TBM in our setting. The current study has shown that age greater than sixty years and the need for mechanical ventilation are significant independent predictors of mortality.

Adolescent↗

PubMed2003

Early predictors of long-term disability after injury.

BACKGROUND: Improving outcomes after serious injury is important to patients, patients' families, and healthcare providers. Identifying early risk factors for long-term disability after injury will help critical care providers recognize patients at risk. OBJECTIVES: To identify early predictors of long-term disability after injury and to ascertain if age, level of disability before injury, posttraumatic psychological distress, and social network factors during hospitalization and recovery significantly contribute to long-term disability after injury. METHODS: A prospective, correlational design was used. Injury-specific information on 63 patients with serious, non-central nervous system injury was obtained from medical records; all other data were obtained from interviews (3 per patient) during a 2 1/2-year period. A model was developed to test the theoretical propositions of the disabling process. Predictors of long-term disability were evaluated using path analysis in the context of structural equation modeling. RESULTS: Injuries were predominately due to motor vehicle crashes (37%) or violent assaults (21%). Mean Injury Severity Score was 13.46, and mean length of stay was 12 days. With structural equation modeling, 36% of the variance in long-term disability was explained by predictors present at the time of injury (age, disability before injury), during hospitalization (psychological distress), or soon after discharge (psychological distress, short-term disability after injury). CONCLUSIONS: Disability after injury is due partly to an interplay between physical and psychological factors that can be identified soon after injury. By identifying these early predictors, patients at risk for suboptimal outcomes can be detected.

Accidents, Traffic↗

PubMed2003

Predictors of bruxism, other oral parafunctions, and tooth wear over a 20-year follow-up period.

AIMS: To analyze predictors of bruxism, other oral parafunctions, and tooth wear in a group of subjects who had been examined 20 years earlier. METHODS: Originally, 402 randomly selected 7-, 11-, and 15-year-old subjects were examined clinically and by means of a questionnaire. Twenty years after the first examination, 94% of the original group could be traced, and 320 (85%) completed and returned the questionnaire. Of the oldest group, 100 (81%) also underwent a clinical examination focusing on occlusal factors and function and dysfunction of the masticatory system. For analyses of predictors of some oral parafunctions and tooth wear registered at the 20-year follow-up, logistic regression was used with recordings at the first examination as independent variables. RESULTS: Subjective reports in childhood of bruxism (defined as tooth clenching during daytime and/or tooth grinding at night), clenching only, grinding at night only, nail biting, and/or other parafunctions were predictors of the same oral parafunctions 20 years later. There were different predictors of the 2 components of bruxism, daytime tooth clenching and tooth grinding at night. Postnormal occlusion (Angle Class II malocclusion) and tooth wear in childhood predicted increased tooth wear in adulthood. Subjects with nonworking-side interference had less anterior tooth wear than those without such interference. CONCLUSION: Oral parafunctions in childhood may be a persistent trait in many subjects. Postnormal occlusion and tooth wear in childhood predicted increased anterior tooth wear 20 years later, whereas nonworking-side interference reduced the risk for such wear in 35-year-old subjects.

Adolescent↗

PubMed1999

Predictors of in-hospital mortality following operative management of hip fractures.

OBJECTIVE: To identify predictors of in-hospital mortality and hospital stay following hip fractures. DESIGN: Retrospective cohort study of 185 consecutive patients. SETTING: Tertiary Care University Hospital. PARTICIPANTS: Individuals requiring operative treatment of a proximal femoral fracture excluding those individuals < 50 years old, with femoral head or subtrochanteric fractures, and significant co-morbidity. OUTCOMES: In-hospital mortality and length of hospital stay (days). RESULTS: 116 patients met the inclusion criteria. Predictors of in-hospital mortality from logistic regression analysis included male gender (odds ratio with 95% CI: 5.5, 1.5-20.5), admission from a long term care facility (5.5, 1.4-22.6), age greater than 90 years (4.5, 0.9-22.1), and living at home with support (0.2, 0.03-0.9). Predictors of hospital stay from multivariate regression analysis in order of magnitude included presence of a post-operative complication (odds ratio with 95% CI: 14.1, 4.7-44), living at home with support (3.4, 1.3-8.9) and older age (> 85 years) (2.7, 1.0-7.3). Moreover, confusion, urinary tract infections and decubitus ulcers accounted for greater than 50% of all complications encountered. A trend between the number of positive predictors and length of hospital stay was observed. CONCLUSIONS: Elderly individuals admitted from a long term care facility are at high risk of mortality following operative fixation of hip fractures. Early recognition and aggressive management of post-operative complications such as confusion, urinary tract infections and decubitus ulcers through careful patient monitoring may decrease hospital stays in those that survive.

Aged↗

PubMed2003

[Significance of acute-phase inflammatory reactants as an indicator of prognosis after acute myocardial infarction: which is the most useful predictor?].

OBJECTIVES: To investigate the relationship between representative acute-phase inflammatory reactants [highly sensitive C-reactive protein (hsCRP), serum amyloid A protein (SAA) and interleukin-6 (IL-6)] and the severity of acute myocardial infarction and patient prognosis, and to identify the most useful predictor of the three. METHODS: This study investigated 132 consecutive patients admitted within 8 hr of onset of first acute myocardial infarction and successfully reperfused with primary percutaneous coronary intervention. Acute-phase (= 24 hr from onset) blood samples were taken for evaluation of inflammatory reactants (hsCRP, SAA and IL-6), and peak creatine phosphokinase levels were measured every 4 hr after admission for 48 hr to assess myocardial infarction infarct size. Left ventriculography was performed in the chronic stage (20 +/- 9 days post-admission) to analyze left ventricular ejection fraction and regional wall motion, using Killip's classification to determine acute myocardial infarction severity. Logistic regression analysis was used to quantify the usefulness of the reactants as predictors of patient prognosis. RESULTS: Both hsCRP and SAA showed significant positive correlations with peak creatine phosphokinase. hsCRP and SAA showed significant inverse correlations with left ventricular ejection fraction and regional wall motion in the chronic stage. Multivariate analysis identified SAA as the best predictor of severe heart failure (Killip's classification III, IV). SAA was the best predictor of a major cardiac event (shock, cardiac death). CONCLUSIONS: These results suggest a strong correlation between acute-phase SAA and the clinical course of patient outcomes after acute myocardial infarction, such as cardiac function, heart failure and cardiac death. SAA may be the most useful acute-phase inflammatory reactant for predicting the prognosis after acute myocardial infarction.

Acute-Phase Proteins↗

PubMed2003

Nutritional predictors of survival in terminally ill cancer patients.

BACKGROUND AND PURPOSE: Malnutrition can affect the prognosis of terminally ill patients, but over-treatment of malnutrition can worsen patients' quality of life. Decisions on nutrition and the supply of fluids to terminally ill patients are complex, and the identification of useful clinical indicators is needed. This study evaluated the relationships between various nutritional indices and survival of terminally ill cancer patients. METHODS: We recruited terminally ill patients from a teaching hospital between February 2000 and January 2001. All of the 145 candidates were cancer patients, 109 (75%) of whom agreed to participate. Nutritional assessments including physical examination, anthropometric measurements, and biochemical profiles were performed on admission. RESULTS: Univariate analyses showed that triceps skin-fold thickness (TSF) and midarm muscle circumference were significant predictors of survival. Poor survival was associated with prealbumin </= 100 mg/L (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.1 to 2.3; p = 0.03), asparate transaminase (AST) > 45 U/L (HR, 1.6; 95% CI, 1.1 to 2.3; p = 0.03), alkaline phosphatase > 120 U/L (HR, 1.6; 95% CI, 1.1 to 2.5; p = 0.02), creatinine > 1.4 mg/dL (HR, 1.9; 95% CI, 1.2 to 3.2; p = 0.01), and blood urea nitrogen (BUN) > 20 mg/dL (HR, 1.9; 95% CI, 1.3 to 2.8; p < 0.01) at admission. Multivariate analyses found that TSF < 25% of the nomogram (HR, 2.9; 95% CI, 1.6 to 5.3; p < 0.01), prealbumin </= 100 mg/L (HR, 2.2; 95% CI, 1.4 to 3.5; p < 0.01), AST > 45 U/L (HR, 2.0; 95% CI, 1.3 to 3.2; p = 0.01), and BUN > 20 mg/dL (HR, 2.8; 95% CI, 1.7 to 4.5; p < 0.01) were independent predictors of poor survival. CONCLUSIONS: This study found that nutritional status was associated with the survival of terminally ill cancer patients. Both TSF and prealbumin appeared to be useful predictors that may help set strategies to improve palliative care. Because predictors of survival are not necessarily factors that actually influence survival, further studies should be conducted to evaluate the usefulness of these prognostic indicators in clinical practice.

Adult↗

PubMed2003

Predictors of early reangiography within 30 days after coronary stenting.

BACKGROUND: A substantial number of early urgent reangiographies after coronary stenting do not reveal coronary abnormalities such as thrombosis, dissection, restenosis or side branch occlusion. The characterization of patients undergoing early reangiography may reduce the number of potentially unnecessary procedures. OBJECTIVE: To evaluate the predictors for unplanned early re- angiography on the basis of the information available at the time of stent implantation. METHODS: All 71 patients with reangiography after stent implantation between 1994 and 1998 in the Department of Cardiology at the University Hospital of Vienna, Austria, were compared with a control sample of 88 patients without early reangiography during the same period (control subjects were matched for the time point of the first intervention). The clinical and procedural variables were analyzed in this case-control study. For specification of the group with negative reangiograms, differences in clinical parameters between patients with negative versus patients with positive reangiograms were also analyzed. RESULTS: Clinical predictors for early reangiography of patients without evidence of important coronary pathology were a history of hypertension and left ventricular hypertrophy, as well as total cholesterol. The angiographic predictor was multiple vessel disease, and procedural risk factors included the left anterior descending artery as the target artery, type B and C lesions and total occlusion in the left anterior descending artery, as well as high-pressure balloon stent deployment. CONCLUSION: Clinical, angiographic and procedural variables predict the risk for unplanned early reangiography after coronary stenting. Hypertensive heart disease may mimic acute coronary events; hypertension and left ventricular hypertrophy represent independent predictors of unplanned reangiography in patients with good short-term results.

Adult↗

PubMed2004

Methods for predictor analysis of repeated measurements: application to psychiatric data.

OBJECTIVES: In schizophrenia research, little attention yet has been directed on methods for analyzing data from studies with repeated measurements over time. Motivation for this research stems from a project within the German Research Network on Schizophrenia, in which an algorithm is developed to guide prodrome-based early intervention strategies in stable first episode patients. METHODS: We present two different approaches for the analysis of correlated response data, the Generalized Estimating Equations (GEE) method and the Artificial Neural Network (ANN) approach. We illustrate the methods using the data of the A.N.I. study, which is one of the largest German multicenter treatment studies in regard to the long-term treatment of schizophrenia conducted between 1983 and 1989. RESULTS: The results of statistical model selection prior to GEE analysis and various data presentation methods for ANNs are presented. The primary goal of our evaluation is to investigate if the defined prodromes are valid predictors for relapse. Additionally, it is shown that both methods are applicable on a realistic data set. CONCLUSIONS: It is concluded that both methods are suitable for predictor analysis especially since all variable time points of the patients are included instead of only selected, so that it can be assumed that results are not biased. With the GEE method a test of association for each predictor can be performed whereas with ANNs a general proposition can be made for prodromes depending on the type of data presentation. Using the A.N.I. data the prodrome 'trouble sleeping' seems to be the most informative predictor. Finally, the important differences of the two methods are discussed.

Algorithms↗

PubMed2003

Predictors of health-promoting behavior of African-American and white caregivers of impaired elders.

Several longitudinal studies have examined declines in health of caregivers, but few have explored the health-promoting behavior Because caregivers neglect their health, they are at risk for developing a number of physical and psychological problems. What is not well known are the factors that contribute to increased health-promoting behavior ultimately preventing poor health and premature death. Therefore, the purpose of this study was to explore the predictors and the change in predictors of health-promoting behavior in African-American and White caregivers over a 3-year period. Pender, Murdaugh, and Parsons' (2002) health promotion model guided the study. This present study is a secondary data analysis of a larger study aimed at examining predictors of health-promoting behavior among 66 African-American (n=66) and 110 (n=110) and White caregivers of impaired older adults recruited primarily through random digit dialing. The larger data set consisted of 391 (N=391) subjects (n=136 African-American; n=255 White). The larger prospective study was based on face-to-face interviews. In the original study, trained interviewers collected data on depression, psychological distress, self-perceived health, religiosity, number of chronic conditions, and demographic characteristics using well-established instruments. Data in this present study were collected at three time points over a three-year period with one-year intervals at Time1 (T1), Time2 (T2), and Time3 (T3). Analysis of the data in this present study suggested that, although, the number of health-promoting behaviors significantly differed for African-American and White caregivers at T1, T2, and T3, no predictors were significantly associated with a change in health-promoting behavior over time. Nonetheless, this finding suggests that nurses can develop useful information in helping to focus more attention on the health of caregivers in the future.

Adult↗

PubMed2004

[Comparison of various methods of assessment of heart rate variability including simple cardiovascular reflex tests as predictors of sudden cardiac death after myocardial infarction.].

UNLABELLED: Long term heart rate variability is used for prediction of sudden cardiac death (SD). There are simpler methods of assessment of autonomic cardiac control - registration of heart rate response to reflex tests and determination of heart rate variability (HRV) on short ECG recordins. Comparative value for prognosis of SD after myocardial infarction (MI) of these 3 techniques has not been studied yet. METHODS: Valsalva maneuver with calculation of Valsalva ratio (VR) and deep breath test with calculation of difference between average maximal and minimal HR during first minute of test (HR difference - HRD) were performed in 188 patients on days 4-11 of MI (68.1% men, age 34-75 years, 93.6% on beta-blockers, without heart failure NYHA IV on the day of tests). Time and frequency domain HRV measures were assessed during 15 min at bed rest and at Holter monitoring for median 24 h on the same day as reflex tests. RESULTS: During follow up for 2.1+/-0.8 years there were 9 sudden and 13 non-sudden cardiac deaths. ROC analysis was used to determine cut-off values of VR, HRD and HRV measures for dichotomization of patients into those with low- and high-risk of SD and these values were used in logistic regression analysis. The following parameters were univariate predictors of SD: obtained at reflex tests - VR <1.13 (OR 7.8, 95% CI 1.6-39.0; p=0.012), HRD <3.36 (OR 4.3, 95% CI 1.1-16.9; p=0.034); HRV parameters from 15 min ECG recordings - total frequency power <739 ms(2), VLF power <294 ms(2), LF power <197 ms(2) and LF/HF <1.5; HRV parameters from long term ECG recording - LF power <491 ms(2), LF/HF <1.4. At multivariate analysis only LF power for 15 min <197 ms(2) among HRV parameters remained independent predictor of SD (OR 24.2, 95% CI 2.4-245.5; p=0.007). Other predictors were clinical - VF during acute phase of MI (OR 94.7, 95% CI 4.2-2115.2; p=0.004) and history of MI (OR 8.4, 95% CI 1.4-48.5; p=0.017). CONCLUSION: In this population of patients without severe heart failure low LF power on 15 min resting ECG recordings on days 4-11 of MI was more powerful predictor of sudden cardiac death during subsequent 2 years than other HRV parameters including heart rate response to Valsalva maneuver and deep breath test.

Death, Sudden, Cardiac↗