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Reference: Ramírez, J, Orini, M, Minchole, A et al., (2017). T-wave morphology restitution predicts sudden cardiac death in patients with chronic heart failure. Journal of the American Heart Association, 6 (5), e005310.Citable link to this page:

 

T-wave morphology restitution predicts sudden cardiac death in patients with chronic heart failure

Abstract: Background: Patients with chronic heart failure (CHF) 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 ECG-based index, TMR, characterizing T-wave morphology restitution, and to assess its association with SCD risk in a population of CHF patients.Methods and Results: Holter ECGs from 651 ambulatory patients with CHF from the MUSIC (MUerte Súbita en Insuficiencia Cardiaca) 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 like 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 vs. 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.Conclusion: This study shows that TMR is specifically associated with SCD in a population of CHF patients and it is a better predictor than clinical and ECG-derived variables.

Publication status:PublishedPeer Review status:Peer reviewedVersion:Publisher's versionDate of acceptance:2017-04-12 Funder: Spanish Ministry of Economy and Competitiveness   Funder: CIBER-BBN   Notes:This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Bibliographic Details

Publisher: Wiley

Publisher Website: http://www.wileyopenaccess.com/view/index.html

Journal: Journal of the American Heart Associationsee more from them

Publication Website: http://jaha.ahajournals.org/

Volume: 6

Issue: 5

Issue Date: 2017-05-19

pages:e005310Identifiers

Doi: https://doi.org/10.1161/JAHA.116.005310

Eissn: 2047-9980

Uuid: uuid:aa92937e-06ad-4cff-aa56-706bdb8f51ff

Urn: uri:aa92937e-06ad-4cff-aa56-706bdb8f51ff

Pubs-id: pubs:692031 Item Description

Type: journal-article;

Version: Publisher's versionKeywords: dispersion of repolarization repolarization restitution T-wave morphology sudden cardiac arrest chronic heart failure

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Autor: Ramírez, J - - - Orini, M - fundingMarie Curie Fellowship grantNumberIEF-2013 - - - Minchole, A - Oxford, MPLS, Computer Science

Fuente: https://ora.ox.ac.uk/objects/uuid:aa92937e-06ad-4cff-aa56-706bdb8f51ff



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