Prognostic significance of the Holter-derived T-wave variability in patients with ventricular tachyarrhythmias complicating acute coronary syndrome—TWIST study

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2023-09-22 DOI:10.1111/anec.13069

Taro Makino MD, Tomohide Ichikawa MD, Mari Amino MD, Mari Nakamura MD, Masayuki Koshikawa MD, Yuji Motoike MD, Yoshihiro Nomura MD, Masahide Harada MD, Yoshihiro Sobue MD, Eiichi Watanabe MD, Ken Kiyono PhD, Koichiro Yoshioka MD, Yuji Ikari MD, Yukio Ozaki MD, Hideo Izawa MD

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Abstract

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.

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动态心电图T波变异性对室性快速心律失常并发急性冠状动脉综合征患者预后的意义TWIST研究。

背景：我们旨在研究心室复极不稳定与48小时内发生的持续性室性心动过速和心室颤动（VT/VF）之间的关系 h（急性期VT/VF）以及出院后复极不稳定性和心率变异性（HRV）的预后作用。方法：我们研究了572例左心室射血分数>35%的ACS患者。心室复极不稳定性是通过使用高分辨率24小时动态心电图（记录在中位数11 天。我们计算了HRV参数，包括减速能力（DC）和在25 s时间尺度（λ25s）。根据先前研究的阈值对DC和λ25s进行二分。结果：43例（7.5%）患者出现急性期VT/VF。VT/VF患者的住院死亡率明显较高（4.7%vs.0.9%，p = .03）。调整后的逻辑模型显示，最大TAV（比值比1.02，95%置信区间[CI]1.00-1.29，p = .04）与急性期VT/VF相关。中位随访期为2.1 年，19名（3.3%）患者出现心脏死亡或复苏性心脏骤停。急性期VT/VF（p = .12）和TAV（p = .72）不是生存的重要预测因素。年龄和性别调整的Cox模型显示DC（p 结论：T波振幅变异性与急性期VT/VF有关，但TAV不能预测出院后的生存率。DC、λ25s和紧急冠状动脉介入治疗是生存率的独立预测因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.