Oscillatory functions affecting outcome of coronary heart disease: the hazard of too much or too little stability.

The objective was to identify physiological and behavioral indicators predictive of sudden arrhythmic death in patients who had experienced myocardial infarction in the past. In a 10-year prospective study of 79 patients, 59 men and 20 women aged 36 to 76 who had suffered a well-documented myocardial infarction (MI) at some time in the past (6 weeks-5 years) were individually matched with healthy controls of age, sex, race, height, weight, educational background and type of job. Both patients and controls were reexamined and retested at intervals of 6-8 weeks throughout the first 7 years of the study. Fifty-three patients died, 7 of noncardiac disorders, 2 died of suicide. Forty-four, 31 men and 13 women died suddenly of apparent MI. Thirty-one, or 70% of them were autopsied. Eleven were found to have experienced a recent MI and 20 had only an old scar. Age was not a determinant of cardiac mortality among the patients. The average age of those who died was 56 and of survivors 53. Neither was the level of serum cholesterol concentration, the LDL/HDL ratio, or the treadmill test a significant determinant of death. The measured physiological data that did significantly correlate to the cardiac deaths at the 0.01 level of confidence were low RR variability or wide mean RR variation month to month, prolonged QT interval or wide mean QT variability month to month. The findings support the view that proper physiological balance requires some degree of instability, but not too little or too much. Walter Cannon in his first paper on homeostasis (Cannon, 1926), credited Charles Richet with this perception "The living being is stable... In a sense it is stable because it is modifiable--the slight instability is the necessary condition for the true stability of the organism" (Richet, 1990).