Prognostic significance of the Holter-derived T-wave variability in patients with ventricular tachyarrhythmias complicating acute coronary syndrome-TWIST study.
arrhythmias
death
electrocardiography
myocardial infarction
Journal
Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
ISSN: 1542-474X
Titre abrégé: Ann Noninvasive Electrocardiol
Pays: United States
ID NLM: 9607443
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
02
05
2023
received:
31
01
2023
accepted:
22
06
2023
medline:
16
11
2023
pubmed:
23
9
2023
entrez:
23
9
2023
Statut:
ppublish
Résumé
We aimed to investigate the association between ventricular repolarization instability and sustained ventricular tachycardia and ventricular fibrillation (VT/VF) occurring within 48 h (acute-phase VT/VF) after the onset of acute coronary syndrome (ACS) and the prognostic role of repolarization instability and heart rate variability (HRV) after discharge from the hospital. We studied 572 ACS patients with a left ventricular ejection fraction >35%. The ventricular repolarization instability was assessed by the beat-to-beat T-wave amplitude variability (TAV) using high-resolution 24-h Holter ECGs recorded at a median of 11 days from the date of admission. We calculated the HRV parameters including the deceleration capacity (DC) and non-Gaussian index calculated on a 25 s timescale (λ25s). The DC and λ25s were dichotomized based on previous studies' thresholds. Acute-phase VT/VF developed in 43 (7.5%) patients. In-hospital mortality was significantly higher among VT/VF patients (4.7% vs. 0.9%, p = .03). An adjusted logistic model showed that the maximum TAV (odds ratio 1.02, 95% confidence interval [CI] 1.00-1.29, p = .04) was associated with acute-phase VT/VF. During a median follow-up period of 2.1 years, 19 (3.3%) patients had cardiac deaths or resuscitated cardiac arrest. Acute-phase VT/VF (p = .12) and TAV (p = .72) were not significant predictors of survival. An age and sex-adjusted Cox model showed that the DC (p < .01), λ25s (p < .01), and emergency coronary intervention (p < .01) were independent predictors. T-wave amplitude variability was associated with acute-phase VT/VF, but the TAV was not predictive of survival post-discharge. The DC, λ25s, and emergency coronary intervention were independent predictors of survival.
Sections du résumé
BACKGROUND
We aimed to investigate the association between ventricular repolarization instability and sustained ventricular tachycardia and ventricular fibrillation (VT/VF) occurring within 48 h (acute-phase VT/VF) after the onset of acute coronary syndrome (ACS) and the prognostic role of repolarization instability and heart rate variability (HRV) after discharge from the hospital.
METHODS
We studied 572 ACS patients with a left ventricular ejection fraction >35%. The ventricular repolarization instability was assessed by the beat-to-beat T-wave amplitude variability (TAV) using high-resolution 24-h Holter ECGs recorded at a median of 11 days from the date of admission. We calculated the HRV parameters including the deceleration capacity (DC) and non-Gaussian index calculated on a 25 s timescale (λ25s). The DC and λ25s were dichotomized based on previous studies' thresholds.
RESULTS
Acute-phase VT/VF developed in 43 (7.5%) patients. In-hospital mortality was significantly higher among VT/VF patients (4.7% vs. 0.9%, p = .03). An adjusted logistic model showed that the maximum TAV (odds ratio 1.02, 95% confidence interval [CI] 1.00-1.29, p = .04) was associated with acute-phase VT/VF. During a median follow-up period of 2.1 years, 19 (3.3%) patients had cardiac deaths or resuscitated cardiac arrest. Acute-phase VT/VF (p = .12) and TAV (p = .72) were not significant predictors of survival. An age and sex-adjusted Cox model showed that the DC (p < .01), λ25s (p < .01), and emergency coronary intervention (p < .01) were independent predictors.
CONCLUSION
T-wave amplitude variability was associated with acute-phase VT/VF, but the TAV was not predictive of survival post-discharge. The DC, λ25s, and emergency coronary intervention were independent predictors of survival.
Identifiants
pubmed: 37740449
doi: 10.1111/anec.13069
pmc: PMC10646380
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13069Subventions
Organisme : Japan Agency for Medical Research and Development
ID : 20hk0102071h0001
Organisme : Japan Society for the Promotion of Science
ID : 21K08140
Organisme : Japan Society for the Promotion of Science
ID : 17K09533
Organisme : Japan Society for the Promotion of Science
ID : 26461094
Informations de copyright
© 2023 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.
Références
Heart Rhythm. 2009 Mar;6(3):332-7
pubmed: 19251207
Circ J. 2015;79(2):318-24
pubmed: 25482297
Ann Noninvasive Electrocardiol. 2023 Nov;28(6):e13069
pubmed: 37740449
Front Physiol. 2011 Sep 30;2:65
pubmed: 21994495
Europace. 2016 Jan;18(1):138-45
pubmed: 25733552
Int J Cardiol. 2005 Dec 7;105(3):262-6
pubmed: 16274766
Lancet. 2006 May 20;367(9523):1674-81
pubmed: 16714188
Europace. 2011 Nov;13(11):1612-8
pubmed: 21712269
Am J Med. 2008 Sep;121(9):797-804
pubmed: 18724970
Circ J. 2016 Jun 24;80(7):1539-47
pubmed: 27238618
Circ Res. 1991 May;68(5):1471-81
pubmed: 2019002
Circulation. 2014 Jun 10;129(23):2426-35
pubmed: 24914016
J Am Coll Cardiol. 2007 Dec 11;50(24):2275-84
pubmed: 18068035
Circ J. 2013;77(3):610-8
pubmed: 23439592
Front Neurosci. 2021 Jan 28;15:610955
pubmed: 33633535
Eur Heart J. 2014 Jan;35(2):116-22
pubmed: 24258072
Nat Rev Cardiol. 2010 Apr;7(4):216-25
pubmed: 20142817
Circ J. 2019 Apr 25;83(5):1085-1196
pubmed: 30930428
Europace. 2012 Nov;14(11):1646-52
pubmed: 22423254
Europace. 2010 Sep;12(9):1302-7
pubmed: 20472689
Europace. 2007 Sep;9(9):717-23
pubmed: 17639070
Eur Heart J. 2009 Mar;30(5):576-83
pubmed: 19109245
Circ Res. 1981 Nov;49(5):1069-81
pubmed: 7028311
J Electrocardiol. 2019 Mar - Apr;53:71-78
pubmed: 30703576
Circulation. 1975 Dec;52(6 Suppl):III96-115
pubmed: 1182986
JAMA. 2009 May 6;301(17):1779-89
pubmed: 19417195
Eur Heart J. 2019 Sep 14;40(35):2940-2949
pubmed: 31049557
J Am Coll Cardiol. 2006 Mar 21;47(6):1161-6
pubmed: 16545646
Rev Esp Cardiol (Engl Ed). 2015 Oct;68(10):878-84
pubmed: 25800166
Circulation. 1984 Apr;69(4):790-800
pubmed: 6697463
N Engl J Med. 2005 Jun 23;352(25):2581-8
pubmed: 15972864
Heart Rhythm. 2017 Apr;14(4):592-598
pubmed: 28104481
Heart Rhythm. 2008 Feb;5(2):261-8
pubmed: 18242551