Force–interval relationship predicts mortality in survivors of myocardial infarction with atrial fibrillation

Sinnecker, Daniel; Barthel, Petra; Huster, Katharina M.; Müller, Alexander; Gebhardt, Josef; Dommasch, Michael; Schneider, Simon; Steger, Alexander; Laugwitz, Karl‐Ludwig; Malik, Marek; Schmidt, Georg

doi:10.1016/j.ijcard.2015.01.018

Cited by 5 publications

(5 citation statements)

References 33 publications

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“…by relating the systolic pressure change to the RR interval change. 18 PESP Afib values were significantly higher in non-survivors than in survivors. When dichotomised at its median, PESP Afib distinguished between patient groups with 5-year mortality rates of 63 % and 19 %, respectively.…”

Section: Post-extrasystolic Potentiation As a Risk Predictor In Cardimentioning

confidence: 72%

“…Therefore, we developed a PESP-analogous parameter (PESP Afib ) and evaluated its association with mortality in a small cohort of 32 MI survivors with atrial fibrillation. 18 The ECGs were screened for short-long sequences, in which a heartbeat interval shorter than 80 % of the local average (P i ) was followed by an interval longer than 140 % of the local average (P i+1 ). Based on the systolic blood pressure values elicited by P i and P i+1 and the corresponding RR intervals (RR i and RR i+1 ), we calculated PESP Afib as (P i+1 -P i ) / (RR i+1 -RR i ),…”

Section: Post-extrasystolic Potentiation As a Risk Predictor In Cardimentioning

confidence: 99%

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Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients

Steger

Sinnecker

Barthel

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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In 1885, Oscar Langendorff was the first person to describe the increase in contractility ('Pulsverstärkung') that follows an extrasystole.1 Langendorff experimented with spontaneously beating isolated frog hearts. He recorded the heartbeats by using a lever that transferred the contractile movements of the heart to a rotating drum. Electrical stimulation resulted in premature contractions that were followed by compensatory pauses. In these experiments, he noticed that myocardial contractility during the first post-ectopic beats was typically stronger compared with the normal beats (see Figure 1A). Decades later, this phenomenon was termed postextrasystolic potentiation (PESP).2 PESP is present at the level of the myocardium, independently of pre-or afterload conditions. 3 The driving force behind the augmented post-extrasystolic contractility is augmented calcium release from the intracellular stores during the post-extrasystolic action potential. 4,5 Historically, PESP has been studied intensively with regard to two possible clinical applications (reviewed in Cooper 3 ):• PESP was induced during contrast ventriculography with the aim of identifying ischaemic but viable myocardial regions that might benefit from revascularisation.• PESP was elicited by paired pacing with the aim of augmenting myocardial contractility in heart failure patients.Besides these now widely abandoned applications, several studies have documented an interesting relationship between PESP and myocardial dysfunction. Post-extrasystolic Potentiation and HeartDisease: A Forgotten Association?PESP can be measured as post-extrasystolic augmentation of the maximum left-ventricular pressure rise (LV dP/dt) or as systolic blood pressure potentiation. The parameter that is most closely related to myocardial contractility is LV dP/dt. At the level of LV dP/dt, PESP was observed both in healthy people and in heart failure patients. 6However, potentiation of LV dP/dt was typically more pronounced in failing than in healthy hearts. 7-10 At the level of blood pressure, it has to be taken into account that systolic blood pressure is not only determined by cardiac output, but also by vascular factors, such as peripheral vascular resistance. When PESP was measured at the level of maximum systolic blood pressure (or maximum LV pressure, which are roughly equivalent in the absence of aortic stenosis), the typical finding in healthy probands was that the first post-ectopic heartbeat elicited a lower pulse wave than the regular ones. By contrast, in heart failure patients, PESP of systolic blood pressure could generally be observed. [6][7][8][9][10] In a series of 100 consecutive patients with coronary artery disease, the pattern of post-extrasystolic blood pressure potentiation was associated with an increased prevalence of congestive heart failure and cardiomegaly as well as with higher left-ventricular end-diastolic pressure, lower cardiac output and lower left-ventricular ejection fraction (LVEF). 11At the cellular level, PESP of contractility is caused ...

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Section: Post-extrasystolic Potentiation As a Risk Predictor In Cardimentioning

confidence: 72%

Section: Post-extrasystolic Potentiation As a Risk Predictor In Cardimentioning

confidence: 99%

Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients

Steger

Sinnecker

Barthel

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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“…Eligible patients had survived acute MI less than four weeks before recruitment, they were aged 80 years or less, had sinus rhythm, and did not meet the criteria for secondary prophylactic implantation of implantable cardioverter defibrillator before hospital discharge. A total of 32 patients did not pass the initial screening due to atrial fibrillation (Sinnecker et al, 2015).…”

Section: Study Cohortmentioning

confidence: 99%

Augmented Oscillations in QT Interval Duration Predict Mortality Post Myocardial Infarction Independent of Heart Rate

et al. 2020

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“…The cause of the difference is not entirely understood, but is presumably due to altered Ca 2+ handling of the myocardial cells [6]. Studies of FIRs have been commonly conducted with invasive measures in laboratory settings, although recently Sinnecker et al [7] stated that FIR assessed by an unobtrusive blood pressure measurement predicts mortality in survivors of myocardial infarction with atrial fibrillation (AF).…”

Section: Introductionmentioning

confidence: 99%

Force-Interval Relationships of the Heart Measured With Photoplethysmography During Atrial Fibrillation

Eerikäinen¹,

Bonomi

Dekker

et al. 2018

2018 Computing in Cardiology Conference (CinC)

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Force-interval relationships (FIRs) of the heart represent the relationships between inter-beat intervals (IBIs) and strength of the ventricular contractions. These relationships are typically measured invasively and are altered from normal in heart failure (HF). An unobtrusive and continuous measurement of FIRs could be beneficial when HF and atrial fibrillation (AF) coexist in order to understand if AF causes progression of HF. We hypothesize that FIRs could be assessed during AF with IBIs and hemodynamic changes captured unobtrusively by photoplethysmography (PPG) at the wrist. FIRs were assessed by using Spearman's rank correlation between the pulse onset change in the PPG waveform and either the preceding or pre-preceding IBIs (r pre and r pre−pre) in 5-minute segments. 32 patients (14 continuous AF, 18 no AF) were measured during the night with PPG and electrocardiography as a reference. The mean and standard deviation of r pre were-0.25 ± 0.08 and 0.05 ± 0.12 (p < 0.0001), and of r pre−pre 0.60 ± 0.09 and 0.16 ± 0.14 (p < 0.0001), during AF and sinus rhythm, respectively. Areas under the Receiver Operating Characteristics curve were 0.987 and 0.998, respectively. Thus, during AF the IBIs correlate with the beat-to-beat changes of blood volume measured with PPG, likely to indicate that FIRs can be measured unobtrusively with the PPG signal.

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Force–interval relationship predicts mortality in survivors of myocardial infarction with atrial fibrillation

Abstract: PESPAfib, a measure for the FIR in patients with AF, can be derived from simultaneous ECG and blood pressure recordings. The results of this pilot study indicate that PESPAfib may be useful to predict adverse outcome in survivors of myocardial infarction suffering from AF.

Cited by 5 publications

References 33 publications

Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients

Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients

Augmented Oscillations in QT Interval Duration Predict Mortality Post Myocardial Infarction Independent of Heart Rate

Force-Interval Relationships of the Heart Measured With Photoplethysmography During Atrial Fibrillation

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