PROGNOSTIČKI ZNAČAJ POINCARE PLOT KAO NELINEARNOG PARAMETRA TEORIJE HAOSA KOD BOLESNIKA S INFARKTOM MIOKARDA

Abstract

Introduction There are different proofs about association of autonomic nervous system dysfunction, especially nonlinear parameters, with higher mortality after myocardial infarction.

Objective The objective of the study was to determine predictive value of Poincaré plot as nonlinear parameter and other significant standard risk predictors: ejection fraction of the left ventricle, late potentials, ventricular arrhythmias, and QT interval.

Method The study included 1081 patients with mean follow-up of 28 months (ranging fom 0-80 months). End-point of the study was cardiovascular mortality. The following diagnostic methods were used during the second week: ECG with commercial software Schiller AT-10: short time spectral analysis of RR variability with analysis of Poincaré plot as nonlinear parameter and late potentials; 24-hour ambulatory ECG monitoring: QT interval, RR interval, QT/RR slope, ventricular arrhythmias (Lown >II); echocardiography examinations: systolic disorder (defined as EF<40 %).

Results There were 103 (9.52%) cardiovascular deaths during the follow-up. In univariate analysis, the following parameters were significantly correlated with mortality: mean RR interval < 800 ms, QT and RR interval space relationship as mean RR interval < 800 ms and QT interval > 350 ms, positive late potentials, systolic dysfunction, Poincaré plot as a point, ventricular arrhythmias (Lown > II). In multivariate analysis, the significant risk predictors were: Poincaré plot as a point and mean RR interval lower than 800 ms.

Conclusion Mean RR interval lower than 800 ms and nonlinear and space presentation of RR interval as a point Poincaré plot were multivariate risk predictors.

Keywords: risk factors; myocardial infarction; Poincaré plot