Abstract 2145: Recovery of Cardiac Autonomic Dysfunction after Acute Myocardial Infarction as a Predictor of Fatal of Near-Fatal Arrhythmic Events
Bibliographic record
Abstract
Background. Changes in cardiac autonomic function have been documented after myocardial infraction (MI), but their significance is unknown. We assessed the amount of recovery of autonomic dysfunction after MI and its significance among the patients with depressed left ventricular ejection fraction (LVEF ≤ 0.40 - CARISMA and ≤ 0.50 - REFINE). Methods and Results. Changes in heart rate variability (dHRV) and turbulence (dHRT) were measured from 24-hour ECG recordings performed 5–21 days and again at six weeks post-MI in 312 patients included in the Cardiac Arrhythmias and Risk Stratification after Myocardial Infarction (CARISMA) study. The primary endpoint was sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) recorded by an implantable device. Non-arrhythmic death was a secondary endpoint. HRV and HRT measures increased significantly from baseline to six weeks post-AMI (p<0.001 for dHRV and p=0.017 for dHRT slope). The patients with attenuated recovery of autonomic function had a higher incidence of VT/VF events (n=25), e.g. those with a dHRT slope < 2.0 ms/RRi (optimized cut-off) had a hazard ratio of 10.2 (95% CI from 1.35 to 77.9, p=0.03) of experiencing the VT or VF. The change of very-low (dVLF) and low-frequency (dLF) spectral components also predicted the VT/VF events (p=0.03 for dVLF and p=0.02 for dLF). Only one patient with a dHRT slope ≥2.0 mm/RRi (n=79) experienced VT/VF event (negative accuracy 99%). Validation was performed in the Risk Estimation Following Infarction Non-invasive Evaluation (REFINE) post-MI population (n=322). Of the 24 fatal or non-fatal cardiac arrests that occurred in REFINE, all but two were identified by a lack of improvement in HRT slope as defined in CARISMA (negative accuracy 98%). The risk of fatal or non-fatal cardiac arrest was 7.0-fold (95% CI from 1.6 to 29.6; p = 0.009) higher in patients without improvement in HRT. Lack of improvement in HRT was not predictive of non-arrhythmic death in either post-MI population. Conclusions. Autonomic function undergoes a substantial improvement early after MI, which is associated with vulnerability to VT or VF. A marked recovery of autonomic dysfunction protects from the occurrence of fatal or near-fatal arrhythmic events after MI despite depressed LVEF
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".