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...

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Autores: Ramírez, J., Orini, M., Mincholé, A., Monasterio, V., Cygankiewicz, I., de Luna, A.B., Martínez, J.P., Pueyo, E., Laguna, P.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Universidad de Zaragoza
Repositorio:Zaguán. Repositorio Digital de la Universidad de Zaragoza
OAI Identifier:oai:zaguan.unizar.es:61630
Acceso en línea:http://zaguan.unizar.es/record/61630
Access Level:acceso abierto
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spelling T-wave morphology restitution predicts sudden cardiac death in patients with chronic heart failureRamírez, J.Orini, M.Mincholé, A.Monasterio, V.Cygankiewicz, I.de Luna, A.B.Martínez, J.P.Pueyo, E.Laguna, P.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.2017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://zaguan.unizar.es/record/61630reponame:Zaguán. Repositorio Digital de la Universidad de Zaragozainstname:Universidad de ZaragozaInglésinfo:eu-repo/grantAgreement/ES/DGA/T96info:eu-repo/grantAgreement/EC/H2020/638284This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No H2020 638284-MODELAGEinfo:eu-repo/grantAgreement/ES/ISCIII/CIBER-BBN-MULTITOOLS2HEARTinfo:eu-repo/grantAgreement/ES/MINECO/DPI2016-75458-Rinfo:eu-repo/grantAgreement/ES/MINECO/TEC2013-42140-Rinfo:eu-repo/grantAgreement/ES/MINECO/TIN2013-41998-Rinfo:eu-repo/semantics/openAccessoai:zaguan.unizar.es:616302026-05-29T13:59:51Z
dc.title.none.fl_str_mv T-wave morphology restitution predicts sudden cardiac death in patients with chronic heart failure
title T-wave morphology restitution predicts sudden cardiac death in patients with chronic heart failure
spellingShingle T-wave morphology restitution predicts sudden cardiac death in patients with chronic heart failure
Ramírez, J.
title_short 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_sort T-wave morphology restitution predicts sudden cardiac death in patients with chronic heart failure
dc.creator.none.fl_str_mv Ramírez, J.
Orini, M.
Mincholé, A.
Monasterio, V.
Cygankiewicz, I.
de Luna, A.B.
Martínez, J.P.
Pueyo, E.
Laguna, P.
author Ramírez, J.
author_facet Ramírez, J.
Orini, M.
Mincholé, A.
Monasterio, V.
Cygankiewicz, I.
de Luna, A.B.
Martínez, J.P.
Pueyo, E.
Laguna, P.
author_role author
author2 Orini, M.
Mincholé, A.
Monasterio, V.
Cygankiewicz, I.
de Luna, A.B.
Martínez, J.P.
Pueyo, E.
Laguna, P.
author2_role author
author
author
author
author
author
author
author
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.
publishDate 2017
dc.date.none.fl_str_mv 2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://zaguan.unizar.es/record/61630
url http://zaguan.unizar.es/record/61630
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/grantAgreement/ES/DGA/T96
info:eu-repo/grantAgreement/EC/H2020/638284
This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No H2020 638284-MODELAGE
info:eu-repo/grantAgreement/ES/ISCIII/CIBER-BBN-MULTITOOLS2HEART
info:eu-repo/grantAgreement/ES/MINECO/DPI2016-75458-R
info:eu-repo/grantAgreement/ES/MINECO/TEC2013-42140-R
info:eu-repo/grantAgreement/ES/MINECO/TIN2013-41998-R
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
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publisher.none.fl_str_mv
dc.source.none.fl_str_mv reponame:Zaguán. Repositorio Digital de la Universidad de Zaragoza
instname:Universidad de Zaragoza
instname_str Universidad de Zaragoza
reponame_str Zaguán. Repositorio Digital de la Universidad de Zaragoza
collection Zaguán. Repositorio Digital de la Universidad de Zaragoza
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