Relationship between heart rate variability and left ventricular remodeling after reperfused first anterior wall acute myocardial infarction

The aim of the present study was to test the hypothesis that inadequate improvement in heart rate variability (HRV) in the healing stage of acute myocardial infarction (AMI) is associated with left ventricular (LV) remodeling. The study group comprised 20 patients (14 men, 6 women; mean age, 61 12 years) with a reperfused first anterior AMI (less than or equal to24h). The standard deviation of normal RR intervals (SDNN) was calculated from the 24-h ambulatory electrocardiogram recorded on day 3 of admission and at predischarge from the hospital. Left ventriculography was performed immediately after primary angioplasty and at predischarge. The change in SDNN (DeltaSDNN) was compared with the change in the LV end-systolic volume index (DeltaLVESVI), a parameter of LV remodeling. SDNN increased from 73+/-19 ms on day 3 to 109+/-35 ms at predischarge (p=0.0003). SDNN at predicharge and DeltaSDNN correlated negatively with DeltaLVESVI (r=-0.52, p=0.02, and r=-0.61, p=0.004, respectively), whereas SDNN on day 3 did not correlate with DeltaLVESVI. Multiple regression analysis selected DeltaLVESVI (p=0.02) as an independent factor of DeltaSDNN. This study indicates that DeltaSDNN and SDNN at predicharge are associated with DeltaLVESVI in patients with a reperfused first anterior wall AMI, indicating that persistently reduced HRV is associated with postinfarction LV remodeling.