Abstract
Non-invasive risk stratification of cardiac patients has been the subject of numerous studies. Most of these investigations either researched unique risk predictors or compared the predictive power of different predictors. Fewer studies suggested a combination of a small number of non-invasive indices to increase the accuracy of high-risk group selection. To advance non-invasive risk assessment of cardiac patients, we propose a combination score (termed the Polyscore) of seven different cardiac risk stratifiers that predominantly quantify autonomic cardiovascular control and regulation, namely the slope of heart rate turbulence, deceleration capacity of heart rate, non-invasively assessed baroreflex sensitivity, resting respiration frequency, expiration triggered sinus arrhythmia, post-ectopic potentiation of systolic blood pressure, and frequency of supraventricular and ventricular ectopic beats. These risk stratification tests have previously been researched and their dichotomies defining abnormal results have been derived from previous reports. The Polyscore combination was defined as the number of positive tests among these seven risk predictors, giving a numerical scale which ranges from 0 (all tests normal) to 7 (all tests abnormal). The Polyscore was tested in a population of 941 contemporarily treated survivors of acute myocardial infarction (median age 61 years, 182 females) of whom 72 (7.65%) died during a 5-year follow-up. In these patients, all the risk predictors combined in the Polyscore were assessed during in-hospital 30-min simultaneous non-invasive recordings of high-frequency orthogonal electrocardiogram, continuous blood pressure and respiration. Compared to Polyscore 0 stratum, the hazard ratios of mortality during follow-up increased almost exponentially in strata 1 through 7 (vs. stratus 0, the hazard ratios were 1.37, 1.96, 7.03, 15.0, 35.7, 48.2, and 114, in strata 1 to 7, respectively; p < 0.0001). This allowed selecting low-risk (Polyscore ≤ 2), intermediate risk (Polyscore 3 or 4) and high-risk (Polyscore ≥ 5) sub-groups of the population that differed greatly in the Kaplan–Meier probabilities of mortality during follow-up. Since the Polyscore was derived from recordings of only 30-min duration, it can be reasonably applied in different clinical situations including population-wide screening. We can therefore conclude that the Polyscore is a reasonable method for cardiac risk stratification that is ready for prospective validation in future independent studies.
Highlights
Non-invasive risk stratification of cardiac patients has been addressed in a broad variety of studies (Josephson et al, 1982; Buxton et al, 1984; Wellens et al, 2014)
Patients were enrolled if aged ≤ 80 years, survived the acute phase of myocardial infarction, were in sinus rhythm, and did not meet the secondary prophylaxis indications for implantation of automatic defibrillators (ICD) implantation before hospital discharge
The numbers of patients in the different Polyscore strata were decreasing from the low-risk to the high-risk strata
Summary
Non-invasive risk stratification of cardiac patients has been addressed in a broad variety of studies (Josephson et al, 1982; Buxton et al, 1984; Wellens et al, 2014). Different risk factors such as left ventricular ejection fraction (LVEF), late potentials, heart rate variability (HRV), and the presence of non-sustained ventricular tachycardia have been compared with the aim of identifying the most powerful risk factor (Farrell et al, 1991). This led, among others, to the present guidelines for the selection of cardiac patients suitable for prophylactic implantation of automatic defibrillators (ICD) (Al-Khatib et al, 2018). It is believed that a truly effective risk prediction requires a combination of different risk factors
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
