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NASA NTRS2008

Career Excess Mortality Risk from Diagnostic Radiological Exams Required for Crewmembers Participating in Long Duration Space Flight

NASA requires astronauts to undergo diagnostic x-ray examinations as a condition for their employment. The purpose of these procedures is to assess the astronaut s overall health and to diagnose conditions that could jeopardize the success of long duration space missions. These include exams for acceptance into the astronaut corps, routine periodic exams, as well as evaluations taken pre and post missions. Issues: According to NASA policy these medical examinations are considered occupational radiological exposures, and thus, are included when computing the astronaut s overall radiation dose and associated excess cancer mortality risk. As such, astronauts and administrators are concerned about the amount of radiation received from these procedures due to the possibility that these additional doses may cause astronauts to exceed NASA s administrative limits, thus disqualifying them from future flights. Methods: Radiation doses and cancer mortality risks following required medical radiation exposures are presented herein for representative male and female astronaut careers. Calculation of the excess cancer mortality risk was performed by adapting NASA s operational risk assessment model. Averages for astronaut height, weight, number of space missions and age at selection into the astronaut corps were used as inputs to the NASA risk model. Conclusion: The results show that the level of excess cancer mortality imposed by all required medical procedures over an entire astronaut s career is approximately the same as that resulting from a single short duration space flight (i.e. space shuttle mission). In short the summation of all medical procedures involving ionizing radiation should have no impact on the number of missions an astronaut can fly over their career. Learning Objectives: 1. The types of diagnostic medical exams which astronauts are subjected to will be presented. 2. The level of radiation dose and excess mortality risk to the average male and female astronaut will be presented.

Dodge, C. W.↗

NASA NTRS2016

Fir Decline and Mortality in the Southern Siberian Mountains

Increased dieback and mortality of dark needle conifer (DNC) stands (composed of fir (Abies sibirica),Siberian pine (Pinus sibirica) and spruce (Picea obovata))were documented in Russia during recent decades. Here we analyzed spatial and temporal patterns of fir decline and mortality in the southern Siberian Mountains based on satellite, in situ and dendrochronological data. The studied stands are located within the boundary between DNC taiga to the north and forest-steppe to the south. Fir decline and mortality were observed to originate where topographic features contributed to maximal water-stress risk, i.e., steep (1825),convex, south-facing slopes with a shallow well-drained root zone. Fir regeneration survived droughts and increased stem radial growth, while upper canopy trees died. Tree ring width(TRW) growth negatively correlated with vapor pressure deficit (VPD), drought index and occurrence of late frosts, and positively with soil water content. Previous year growth conditions (i.e., drought index, VPD, soil water anomalies)have a high impact on current TRW (r 0.600.74). Fir mortality was induced by increased water stress and severe droughts (as a primary factor) in synergy with bark-beetles and fungi attacks (as secondary factors). Dendrochronology data indicated that fir mortality is a periodic process. In a future climate with increased aridity and drought frequency, fir (and Siberian pine) may disappear from portions of its current range (primarily within the boundary with the forest steppe)and is likely to be replaced by drought-tolerant species such as Pinus sylvestris and Larix sibirica.

Kharuk, Viacheslav I.↗

NASA NTRS2022

Arizona Water Resources: Utilizing Aerial Imagery and NASA Earth Observations to Assess Pinyon-Juniper Tree Mortality in Flagstaff, AZ

Pinyon-juniper woodlands (PJW) are a vital habitat and food source for several wildlife species and a source of both utility and cultural importance for Indigenous groups. In 2021, amidst a decades-long drought, an extensive juniper mortality event occurred at Wupatki National Monument (WNM) in Arizona. In response, the National Park Service (NPS) is evaluating which land management practices will be beneficial. In partnership with the NPS, the NASA DEVELOP team used remote sensing data to map PJW mortality and analyze the relation of tree mortality to stand density, climate, and topography in north-central Arizona from 2015 to 2021. To identify the extent of PJW, the team performed an unsupervised classification using National Agricultural Imagery Program (NAIP) data with validation sources including NPS-created land cover maps, Landscape Fire and Resource Management Planning Tools (LANDFIRE), NPS and United States Forest Service (USFS) vegetation maps, and Landsat 8 Operational Land Imager (OLI) and Thermal Infrared Sensor (TIRS) data. Terra Moderate Resolution Imaging Spectroradiometer (MODIS), Global Precipitation Measurement (GPM) Integrated Multi-satellite Retrievals for GPM (IMERG), Soil Moisture Active Passive (SMAP), Shuttle Radar Topography Mission (SRTM), and Landsat 8-derived Normalized Difference Vegetation Index (NDVI) and Normalized Difference Moisture Index (NDMI) were used to analyze factors contributing to pinyon-juniper mortality. Although no relationships were found in the broader study region, PJW mortality was weakly correlated to elevation, soil moisture, and land surface temperature within WNM. Results from this study can inform NPS vegetation management that best protects natural and cultural resources.

Margaret Jaenicke↗

NASA NTRS1993

Longitudinal study of astronaut health: Mortality in the years 1959-1991

We conducted a historical cohort study of mortality among 195 astronauts who were exposed to space and medical sources of radiation between 1959 and 1991. Cumulative occupational and medical radiation exposures were obtained from the astronaut radiation exposure history data base. Causes of death were obtained from obligatory death certificates and autopsy reports that were on file in the medical records. A total of 18 deaths occurred during the 32-year follow-up period for which the all-cause standardized mortality ratio (SMR) was 142 (95 percent confidence interval 84 225). There was one cancer death in the buccal cavity and pharynegeal ICD-9 rubric whose occurrence was significantly beyond expectation. Mortality for coronary disease was 59 percent lower than expected (2 deaths; SMR = 41; 95 percent confidence limit 5 147). The crude death rate for 10 occupationally related accidents was 400 deaths per 100,000 person-years, which is an order of magnitude greater than accidental death rates in mining industries. The SMR of 1027 for fatal accidents was significantly beyond expectation (14 deaths; 95 percent confidence limit 561 1723) and was similar to SMRs for accidents among aerial pesticide applications. The 10-year cumulative risk of occupational fatalities based on the exponential, Weibull, Gompertz, and linear-exponential distributions was 10 percent. Mortality from motor vehicle accidents was slightly higher than expected but was not significant (1 death; SMR = 145; 95 percent confidence limit 2 808). Radiation exposures from medical procedures accounted for a majority of cumulative dose when compared with space radiation exposures. The results of the study do not confirm the impression that astronauts are at increased risk of cancer, but this does not obviate the need for further study. Overall, it was found that astronauts are at a health disadvantage as a result of catastrophic accidents.

Peterson, Leif E.↗

NASA NTRS2003

Mortality of atomic bomb survivors predicted from laboratory animals

Exposure, pathology and mortality data for mice, dogs and humans were examined to determine whether accurate interspecies predictions of radiation-induced mortality could be achieved. The analyses revealed that (1) days of life lost per unit dose can be estimated for a species even without information on radiation effects in that species, and (2) accurate predictions of age-specific radiation-induced mortality in beagles and the atomic bomb survivors can be obtained from a dose-response model for comparably exposed mice. These findings illustrate the value of comparative mortality analyses and the relevance of animal data to the study of human health effects.

NASA Discipline Radiation Health↗

NASA NTRS1999

Fractal analysis of heart rate dynamics as a predictor of mortality in patients with depressed left ventricular function after acute myocardial infarction. TRACE Investigators. TRAndolapril Cardiac Evaluation

A number of new methods have been recently developed to quantify complex heart rate (HR) dynamics based on nonlinear and fractal analysis, but their value in risk stratification has not been evaluated. This study was designed to determine whether selected new dynamic analysis methods of HR variability predict mortality in patients with depressed left ventricular (LV) function after acute myocardial infarction (AMI). Traditional time- and frequency-domain HR variability indexes along with short-term fractal-like correlation properties of RR intervals (exponent alpha) and power-law scaling (exponent beta) were studied in 159 patients with depressed LV function (ejection fraction <35%) after an AMI. By the end of 4-year follow-up, 72 patients (45%) had died and 87 (55%) were still alive. Short-term scaling exponent alpha (1.07 +/- 0.26 vs 0.90 +/- 0.26, p <0.001) and power-law slope beta (-1.35 +/- 0.23 vs -1.44 +/- 0.25, p <0.05) differed between survivors and those who died, but none of the traditional HR variability measures differed between these groups. Among all analyzed variables, reduced scaling exponent alpha (<0.85) was the best univariable predictor of mortality (relative risk 3.17, 95% confidence interval 1.96 to 5.15, p <0.0001), with positive and negative predictive accuracies of 65% and 86%, respectively. In the multivariable Cox proportional hazards analysis, mortality was independently predicted by the reduced exponent alpha (p <0.001) after adjustment for several clinical variables and LV function. A short-term fractal-like scaling exponent was the most powerful HR variability index in predicting mortality in patients with depressed LV function. Reduction in fractal correlation properties implies more random short-term HR dynamics in patients with increased risk of death after AMI.

Non-NASA Center↗

NASA NTRS2009

An Update on Mortality in the U.S. Astronaut Corps: 1959-2009

Although it has now been over 50 years since mankind first ventured into space, the long-term health impacts of human space flight remain largely unknown. Identifying factors that affect survival and prognosis among those who participate in space flight is vitally important, as the era of commercial space flight approaches and NASA prepares for missions to Mars. The Longitudinal Study of Astronaut Health is a prospective study designed to examine trends in astronaut morbidity and mortality. The purpose of this analysis was to describe and explore predictors of overall and cause-specific mortality among individuals selected for the U.S. astronaut corps. All U.S. astronauts (n=321), regardless of flight status, were included in this analysis. Death certificate searches were conducted to ascertain vital status and cause of death through April 2009. Data were collected from medical records and lifestyle questionnaires. Multivariable Cox regression modeling was used to calculate the mortality hazard associated with embarking on space flight, adjusted for sex, race, and age at selection. Between 1959 and 2009, there were 39 (12.1%) deaths. Of these deaths, 18 (42.2%) were due to occupational accidents; 7 (17.9%) were due to other accidents; 6 (15.4%) were attributable to cancer; 6 (15.4%) resulted from cardiovascular/circulatory diseases; and 2 (5.1%) were from other causes. Participation in space flight did not significantly increase mortality hazard over time (adjusted hazard ratio=0.57; 95% confidence interval=0.26-1.26. Because our results are based on a small sample size, future research that includes payload specialists, other space flight participants, and international crew members is warranted to maximize statistical power.

Amirian, E.↗

NASA NTRS2014

Impacts of Intercontinental Transport of Anthropogenic Fine Particulate Matter on Human Mortality

Fine particulate matter with diameter of 2.5 microns or less (PM2.5) is associated with premature mortality and can travel long distances, impacting air quality and health on intercontinental scales. We estimate the mortality impacts of 20 % anthropogenic primary PM2.5 and PM2.5 precursor emission reductions in each of four major industrial regions (North America, Europe, East Asia, and South Asia) using an ensemble of global chemical transport model simulations coordinated by the Task Force on Hemispheric Transport of Air Pollution and epidemiologically-derived concentration-response functions. We estimate that while 93-97 % of avoided deaths from reducing emissions in all four regions occur within the source region, 3-7 % (11,500; 95 % confidence interval, 8,800-14,200) occur outside the source region from concentrations transported between continents. Approximately 17 and 13 % of global deaths avoided by reducing North America and Europe emissions occur extraregionally, owing to large downwind populations, compared with 4 and 2 % for South and East Asia. The coarse resolution global models used here may underestimate intraregional health benefits occurring on local scales, affecting these relative contributions of extraregional versus intraregional health benefits. Compared with a previous study of 20 % ozone precursor emission reductions, we find that despite greater transport efficiency for ozone, absolute mortality impacts of intercontinental PM2.5 transport are comparable or greater for neighboring source-receptor pairs, due to the stronger effect of PM2.5 on mortality. However, uncertainties in modeling and concentration-response relationships are large for both estimates.

human health↗

NASA NTRS2014

Abrupt Increases in Amazonian Tree Mortality Due to Drought-Fire Interactions

Interactions between climate and land-use change may drive widespread degradation of Amazonian forests. High-intensity fires associated with extreme weather events could accelerate this degradation by abruptly increasing tree mortality, but this process remains poorly understood. Here we present, to our knowledge, the first field-based evidence of a tipping point in Amazon forests due to altered fire regimes. Based on results of a large-scale, longterm experiment with annual and triennial burn regimes (B1yr and B3yr, respectively) in the Amazon, we found abrupt increases in fire-induced tree mortality (226 and 462%) during a severe drought event, when fuel loads and air temperatures were substantially higher and relative humidity was lower than long-term averages. This threshold mortality response had a cascading effect, causing sharp declines in canopy cover (23 and 31%) and aboveground live biomass (12 and 30%) and favoring widespread invasion by flammable grasses across the forest edge area (80 and 63%), where fires were most intense (e.g., 220 and 820 kW x m(exp −1)). During the droughts of 2007 and 2010, regional forest fires burned 12 and 5% of southeastern Amazon forests, respectively, compared with less than 1% in nondrought years. These results show that a few extreme drought events, coupled with forest fragmentation and anthropogenic ignition sources, are already causing widespread fire-induced tree mortality and forest degradation across southeastern Amazon forests. Future projections of vegetation responses to climate change across drier portions of the Amazon require more than simulation of global climate forcing alone and must also include interactions of extreme weather events, fire, and land-use change.

MODIS↗

NASA NTRS2017

Determination of the Risk of Radiation-Associated Circulatory and Cancer Disease Mortality in a NASA Early Astronaut Cohort

Of the many possible health challenges posed during extended exploratory missions to space, the effects of space radiation on cardiovascular disease and cancer are of particular concern. There are unique challenges to estimating those radiation risks; care and appropriate and rigorous methodology should be applied when considering small cohorts such as the NASA astronaut population. The objective of this work was to determine if there was sufficient evidence for excess risk of cardiovascular disease and cancer in early NASA astronaut cohorts. NASA astronauts in selection groups 1-7 were chosen; this relatively homogeneous cohort consists of 73 white males, who unlike today's astronauts, maintained similar smoking and drinking habits to the general US population, and have published radiation doses. The participants flew in space on missions Mercury through Shuttle and received space radiation doses between 0-74.1 milligrays. Cause of death information was obtained from the Lifetime Surveillance of Astronaut Health (LSAH) program at NASA Johnson Space Center. Mortality was compared with the US male population. Trends of mortality with dose were assessed using a logistic model, fitted by maximum likelihood. Only 32 (43.84 percent) of the 73 early astronauts have died. Standard mortality ratios (SMRs) for cancer (n=7, SMR=43.4, 95 percent CI 17.8, 84.9), all circulatory disease (n=7, SMR=33.2, 95 percent CI 13.7, 65.0), and ischemic heart disease (IHD) (n=5, SMR=40.1, 95 percent CI 13.2, 89.4) were significantly lower than for the US white male population. For cerebrovascular disease, the upper confidence interval for SMR included 100, indicating it was not significantly different from the US population (n=2, SMR = 77.0, 95 percent CI 9.4, 268.2). The power of the study is low and remains below 10 percent even when risks 10 times those reported in the literature are assumed. Due to small sample size, there is currently insufficient statistical power to evaluate space radiation exposure effects on mortality in NASA astronauts. In addition to a comprehensive longitudinal study of NASA astronauts, a research strategy of low dose epidemiology data integration with cell and animal studies should be utilized for space radiation risk assessment in the astronauts.

Elgart, S. R.↗

NASA NTRS1995

Association of particulate air pollution and acute mortality: involvement of ultrafine particles?

Recent epidemiological studies show an association between particulate air pollution and acute mortality and morbidity down to ambient particle concentrations below 100 micrograms/m3. Whether this association also implies a causality between acute health effects and particle exposure at these low levels is unclear at this time; no mechanism is known that would explain such dramatic effects of low ambient particle concentrations. Based on results of our past and most recent inhalation studies with ultrafine particles in rats, we propose that such particles, that is, particles below approximately 50 nm in diameter, may contribute to the observed increased mortality and morbidity In the past we demonstrated that inhalation of highly insoluble particles of low intrinsic toxicity, such as TiO2, results in significantly increased pulmonary inflammatory responses when their size is in the ultrafine particle range, approximately 20 nm in diameter. However, these effects were not of an acute nature and occurred only after prolonged inhalation exposure of the aggregated ultrafine particles at concentrations in the milligrams per cubic meter range. In contrast, in the course of our most recent studies with thermodegradation products of polytetrafluoroethylene (PTFE) we found that freshly generated PTFE fumes containing singlet ultrafine particles (median diameter 26 nm) were highly toxic to rats at inhaled concentrations of 0.7-1.0 x 10(6) particles/cm3, resulting in acute hemorrhagic pulmonary inflammation and death after 10-30 min of exposure. We also found that work performance of the rats in a running wheel was severely affected by PTFE fume exposure. These results confirm reports from other laboratories of the highly toxic nature of PTFE fumes, which cannot be attributed to gas-phase components of these fumes such as HF, carbonylfluoride, or perfluoroisobutylene, or to reactive radicals. The calculated mass concentration of the inhaled ultrafine PTFE particles in our studies was less than 60 micrograms/m3, a very low value to cause mortality in healthy rats. Aging of the fumes with concomitant aggregation of the ultrafine particles significantly decreases their toxicity. Since ultrafine particles are always present in the urban atmosphere, we suggest that they play a role in causing acute lung injury in sensitive parts of the population.

NASA Discipline Environmental Health↗

NASA NTRS2013

Climate Induced Birch Mortality in Trans-Baikal Lake Region, Siberia

The Trans-Baikal (or Zabailkal'e) region includes the forest-steppe ecotones south and east of Lake Baikal in Russia and has experienced drought for several years. The decline and mortality of birch (Betula pendula) stands within the forest-steppe ecotone Trans-Baikal region was studied based on a temporal series of satellite data, ground measurements, and tree ring analysis. During the first decade of the 21st century birch stands decline and mortality were observed on )about 5% of the total area of stands within our 1250 km(exp 2 study area. Birch forest decline and mortality occurs mainly at the margins of stands, within the forest-steppe ecotone on slopes with direct insolation. During the first decade of the 21st century summer (June-August) precipitation was about 25% below normal. Soil water content measurements were lowest within dead stands and highest within healthy stands and intermediate within damaged stands. Drought impact on stands was amplified by an increase in summer air temperatures (+0.9 C) in comparison with the previous decade. Tree ring data of ''surviving'' and ''dead'' tree groups showed a positive correlation with summer/annual precipitation and negative correlation with summer air temperatures. Temperature and precipitation extreme anomalies tend to occur in the region with a period of about 27 years. The observed anomaly was the most severe since the beginning of meteorological observations in the year 1900. Data for the other sites showed a positive climate impact on the growth and expansion of Siberian forests. That is, the same species (B. pendula) showed considerable increase (1.4 times both in height and stem volume) during 20th-21st centuries as temperature increased but precipitation remained at adequate levels.

Forest die-off↗

NASA NTRS2013

Global Premature Mortality Due to Anthropogenic Outdoor Air Pollution and the Contribution of Past Climate Change

Increased concentrations of ozone and fine particulate matter (PM2.5) since preindustrial times reflect increased emissions, but also contributions of past climate change. Here we use modeled concentrations from an ensemble of chemistry–climate models to estimate the global burden of anthropogenic outdoor air pollution on present-day premature human mortality, and the component of that burden attributable to past climate change. Using simulated concentrations for 2000 and 1850 and concentration–response functions (CRFs), we estimate that, at present, 470 000 (95% confidence interval, 140 000 to 900 000) premature respiratory deaths are associated globally and annually with anthropogenic ozone, and 2.1 (1.3 to 3.0) million deaths with anthropogenic PM2.5-related cardiopulmonary diseases (93%) and lung cancer (7%). These estimates are smaller than ones from previous studies because we use modeled 1850 air pollution rather than a counterfactual low concentration, and because of different emissions. Uncertainty in CRFs contributes more to overall uncertainty than the spread of model results. Mortality attributed to the effects of past climate change on air quality is considerably smaller than the global burden: 1500 (−20 000 to 27 000) deaths yr (exp -1) due to ozone and 2200 (−350 000 to 140 000) due to PM2.5. The small multi-model means are coincidental, as there are larger ranges of results for individual models, reflected in the large uncertainties, with some models suggesting that past climate change has reduced air pollution mortality.

human health↗

NASA NTRS1979

Analysis of population mortality kinetics with application to the longevity followup of the Navy's '1,000 aviators'

A simple physiological model of mortality kinetics is used to assess the intuitive concept that the aging rates of populations are proportional to their mortality rates. It is assumed that the vitality of an individual can be expressed as a simple summation of the weighted functional capacities of its organs and homeostatic systems that are indispensable for survival. It is shown that the mortality kinetics of a population can be derived by a linear transformation of the frequency distribution of vitality, assuming a uniform constant rate of decline of the physiological functions. A simple comparison of two populations is not possible when they have different vitality frequency distributions. Analysis of the data using the model suggests that the differences in decline of survivorship with age between the military pilot population, a medically insured population, and the control population can be accounted for by the effect of physical selection on the vitality frequency distribution of the screened populations.

Economos, A. C.↗

NASA NTRS1988

Dinosaur bone beds and mass mortality: Implications for the K-T extinction

Mass accumulations of fossilized large terrestrial vertebrate skeletons (bone beds: BB) provide a test for K-T catastrophic extinction hypotheses. The two major factors contributing to BB formation are mode of death and sedimentation rate. Catastrophic mass mortality (CMM) is the sudden death of numerous individuals where species, age, health, gender, or social ranking offer no survivorship advantage. Noncatastrophic mass mortality (NCMM) occurs over time and is strongly influenced by species, age, or gender. In addition to cause of death, sedimentation rate is also important in BB formation. Models of BBs can be made. The CMM drops all individuals in their tracks, therefore, the BB should reflect the living population with respect to species, age, or gender. The NCMM results in monospecific BBs skewed in the direction of the less fit, usually the very young or very old, or towards a specific gender. The NCMM and AM BBs may become more similar the more spread out over time NCMM deaths occur because carcasses are widely scattered requiring hydraulic accumulation, and the greater time allows for more disarticulation and weathering. The CMM and NCMM BB appear to be dominated by social animals. Applying this and the characteristics of mortality patterns to the uppermost Cretaceous Hell Creek Formation indicates that only NCMM and AM BB occur. Furthermore, NCMM BB are rare in the upper third of the Hell Creek. Near the K-T boundary, only AM BB are known. The absence of CMM and NCMM BB appears to be real reflecting a decrease in population levels of some dinosaurs prior to the K-T event. The absence of CMM suggests that the K-T event did not lead to an instantaneous extinction of dinosaurs. Nor was there a protracted die-off due to an asteroid impact winter, because no NCMM BB are known at or near the K-T boundary.

Carpenter, Kenneth↗

NASA NTRS2020

Smoking and Mortality Among US Astronauts

Astronauts have lower age-specific mortality risk than the U.S. general population from all natural causes of death, particularly cardiovascular disease and cancer. Yet, understanding if they are as healthy as their backgrounds predict they should be, requires that epidemiologists understand (and measure) all potentially confounding exposures in this cohort. Tobacco smoking prevalence has been measured in the U.S. astronaut cohort, but its impact on mortality has not been previously assessed. If smoking history has a negative impact on mortality, this could confound attempts to measure the relative health of astronauts.

Reynolds, Robert J.↗

NASA NTRS1972

Radiation carcinogenesis and acute radiation mortality in the rat as produced by 2.2 GeV protons

Biological studies, proton carcinogenesis, the interaction of protons and gamma-rays on carcinogenesis, proton-induced acute mortality, and chemical protection against proton-induced acute mortality were studied in the rat and these proton-produced responses were compared to similar responses produced by gamma-rays or X-rays. Litter-mate mice were assigned to each experimental and control group so that approximately equal numbers of litter mates were placed in each group. Animals to be studied for mammary neoplasia were handled for 365 days post-exposure when all animals alive were killed. All animals were examined frequently for mammary tumors and as these were found, they were removed, sectioned and given a pathologic classification.

Shellabarger, C. J.↗

NASA NTRS2000

Fractal correlation properties of R-R interval dynamics and mortality in patients with depressed left ventricular function after an acute myocardial infarction

BACKGROUND: Preliminary data suggest that the analysis of R-R interval variability by fractal analysis methods may provide clinically useful information on patients with heart failure. The purpose of this study was to compare the prognostic power of new fractal and traditional measures of R-R interval variability as predictors of death after acute myocardial infarction. METHODS AND RESULTS: Time and frequency domain heart rate (HR) variability measures, along with short- and long-term correlation (fractal) properties of R-R intervals (exponents alpha(1) and alpha(2)) and power-law scaling of the power spectra (exponent beta), were assessed from 24-hour Holter recordings in 446 survivors of acute myocardial infarction with a depressed left ventricular function (ejection fraction </=35%). During a mean+/-SD follow-up period of 685+/-360 days, 114 patients died (25.6%), with 75 deaths classified as arrhythmic (17.0%) and 28 as nonarrhythmic (6.3%) cardiac deaths. Several traditional and fractal measures of R-R interval variability were significant univariate predictors of all-cause mortality. Reduced short-term scaling exponent alpha(1) was the most powerful R-R interval variability measure as a predictor of all-cause mortality (alpha(1) <0.75, relative risk 3.0, 95% confidence interval 2.5 to 4.2, P<0.001). It remained an independent predictor of death (P<0.001) after adjustment for other postinfarction risk markers, such as age, ejection fraction, NYHA class, and medication. Reduced alpha(1) predicted both arrhythmic death (P<0.001) and nonarrhythmic cardiac death (P<0.001). CONCLUSIONS: Analysis of the fractal characteristics of short-term R-R interval dynamics yields more powerful prognostic information than the traditional measures of HR variability among patients with depressed left ventricular function after an acute myocardial infarction.

Non-NASA Center↗