T‐Wave Morphology Restitution Predicts Sudden Cardiac Death in Patients With Chronic Heart Failure
Background Patients with chronic heart failure are at high risk of sudden cardiac death (SCD). Increased dispersion of repolarization restitution has been associated with SCD, and we hypothesize that this should be reflected in the morphology of the T‐wave and its variations with heart rate. The aim...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.005310 |
| _version_ | 1811329030099566592 |
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| author | Julia Ramírez Michele Orini Ana Mincholé Violeta Monasterio Iwona Cygankiewicz Antonio Bayés de Luna Juan Pablo Martínez Esther Pueyo Pablo Laguna |
| author_facet | Julia Ramírez Michele Orini Ana Mincholé Violeta Monasterio Iwona Cygankiewicz Antonio Bayés de Luna Juan Pablo Martínez Esther Pueyo Pablo Laguna |
| author_sort | Julia Ramírez |
| collection | DOAJ |
| description | Background Patients with chronic heart failure are at high risk of sudden cardiac death (SCD). Increased dispersion of repolarization restitution has been associated with SCD, and we hypothesize that this should be reflected in the morphology of the T‐wave and its variations with heart rate. The aim of this study is to propose an electrocardiogram (ECG)‐based index characterizing T‐wave morphology restitution (TMR), and to assess its association with SCD risk in a population of chronic heart failure patients. Methods and Results Holter ECGs from 651 ambulatory patients with chronic heart failure from the MUSIC (MUerte Súbita en Insuficiencia Cardiaca) study were available for the analysis. TMR was quantified by measuring the morphological variation of the T‐wave per RR increment using time‐warping metrics, and its predictive power was compared to that of clinical variables such as the left ventricular ejection fraction and other ECG‐derived indices, such as T‐wave alternans and heart rate variability. TMR was significantly higher in SCD victims than in the rest of patients (median 0.046 versus 0.039, P<0.001). When TMR was dichotomized at TMR=0.040, the SCD rate was significantly higher in the TMR≥0.040 group (P<0.001). Cox analysis revealed that TMR≥0.040 was strongly associated with SCD, with a hazard ratio of 3.27 (P<0.001), independently of clinical and ECG‐derived variables. No association was found between TMR and pump failure death. Conclusions This study shows that TMR is specifically associated with SCD in a population of chronic heart failure patients, and it is a better predictor than clinical and ECG‐derived variables. |
| first_indexed | 2024-04-13T15:36:35Z |
| format | Article |
| id | doaj.art-5e0feade18934bdd953209aa55409455 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T15:36:35Z |
| publishDate | 2017-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-5e0feade18934bdd953209aa554094552022-12-22T02:41:16ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-05-016510.1161/JAHA.116.005310T‐Wave Morphology Restitution Predicts Sudden Cardiac Death in Patients With Chronic Heart FailureJulia Ramírez0Michele Orini1Ana Mincholé2Violeta Monasterio3Iwona Cygankiewicz4Antonio Bayés de Luna5Juan Pablo Martínez6Esther Pueyo7Pablo Laguna8Biomedical Signal Interpretation and Computational Simulation (BSICoS) Group Aragón Institute of Engineering Research IIS Aragón University of Zaragoza SpainInstitute of Cardiovascular Science University College London London United KingdomDepartment of Computer Science University of Oxford Oxford United KingdomUniversidad San Jorge Villanueva de Gallego SpainDepartment of Electrocardiology Medical University of Lodz Lodz PolandCatalan Institute of Cardiovascular Sciences Santa Creu I Sant Pau Hospital Barcelona SpainBiomedical Signal Interpretation and Computational Simulation (BSICoS) Group Aragón Institute of Engineering Research IIS Aragón University of Zaragoza SpainBiomedical Signal Interpretation and Computational Simulation (BSICoS) Group Aragón Institute of Engineering Research IIS Aragón University of Zaragoza SpainBiomedical Signal Interpretation and Computational Simulation (BSICoS) Group Aragón Institute of Engineering Research IIS Aragón University of Zaragoza SpainBackground Patients with chronic heart failure are at high risk of sudden cardiac death (SCD). Increased dispersion of repolarization restitution has been associated with SCD, and we hypothesize that this should be reflected in the morphology of the T‐wave and its variations with heart rate. The aim of this study is to propose an electrocardiogram (ECG)‐based index characterizing T‐wave morphology restitution (TMR), and to assess its association with SCD risk in a population of chronic heart failure patients. Methods and Results Holter ECGs from 651 ambulatory patients with chronic heart failure from the MUSIC (MUerte Súbita en Insuficiencia Cardiaca) study were available for the analysis. TMR was quantified by measuring the morphological variation of the T‐wave per RR increment using time‐warping metrics, and its predictive power was compared to that of clinical variables such as the left ventricular ejection fraction and other ECG‐derived indices, such as T‐wave alternans and heart rate variability. TMR was significantly higher in SCD victims than in the rest of patients (median 0.046 versus 0.039, P<0.001). When TMR was dichotomized at TMR=0.040, the SCD rate was significantly higher in the TMR≥0.040 group (P<0.001). Cox analysis revealed that TMR≥0.040 was strongly associated with SCD, with a hazard ratio of 3.27 (P<0.001), independently of clinical and ECG‐derived variables. No association was found between TMR and pump failure death. Conclusions This study shows that TMR is specifically associated with SCD in a population of chronic heart failure patients, and it is a better predictor than clinical and ECG‐derived variables.https://www.ahajournals.org/doi/10.1161/JAHA.116.005310chronic heart failuredispersion of repolarizationrepolarization restitutionsudden cardiac deathT‐wave morphology |
| spellingShingle | Julia Ramírez Michele Orini Ana Mincholé Violeta Monasterio Iwona Cygankiewicz Antonio Bayés de Luna Juan Pablo Martínez Esther Pueyo Pablo Laguna T‐Wave Morphology Restitution Predicts Sudden Cardiac Death in Patients With Chronic Heart Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease chronic heart failure dispersion of repolarization repolarization restitution sudden cardiac death T‐wave morphology |
| title | T‐Wave Morphology Restitution Predicts Sudden Cardiac Death in Patients With Chronic Heart Failure |
| title_full | T‐Wave Morphology Restitution Predicts Sudden Cardiac Death in Patients With Chronic Heart Failure |
| title_fullStr | T‐Wave Morphology Restitution Predicts Sudden Cardiac Death in Patients With Chronic Heart Failure |
| title_full_unstemmed | T‐Wave Morphology Restitution Predicts Sudden Cardiac Death in Patients With Chronic Heart Failure |
| title_short | T‐Wave Morphology Restitution Predicts Sudden Cardiac Death in Patients With Chronic Heart Failure |
| title_sort | t wave morphology restitution predicts sudden cardiac death in patients with chronic heart failure |
| topic | chronic heart failure dispersion of repolarization repolarization restitution sudden cardiac death T‐wave morphology |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.005310 |
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