Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan.
J Cardiovasc Electrophysiol. 2018 Sep;29(9):1257-1264. doi: 10.1111/jce.13639. Epub 2018 Jun 6.
Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of HF patients.
Our study comprised 215 patients (144 males, mean age 62 years) who had been hospitalized due to acute decompensated HF. Electrocardiogram (QRS duration and QTc interval) and 24-hour Holter monitoring (heart rate variability, heart rate turbulence, and T-wave alternans [TWA]) were performed in stable condition before discharge. The clinical characteristics and outcomes were then investigated.
During a median follow-up period of 2.7 years, there were 83 (38.6%) cardiac events (rehospitalization due to worsening HF [n = 51] or cardiac death [n = 32]). The patients with cardiac events had a lower turbulence slope (TS) and higher TWA compared to those without cardiac events (TS, 3.0 ± 5.5 ms/RR vs. 5.3 ± 5.6 ms/RR, P = 0.001; TWA, 66.1 ± 19.6 μV vs. 54.7 ± 15.1 μV, P < 0.001). Univariable analysis showed that TS, TWA, QRS duration, and QTc interval were associated with cardiac events (P = 0.004, P < 0.001, P = 0.037, and P = 0.024, respectively), while the multivariable analysis after the adjustment of multiple confounders showed that TS and TWA were independent predictive factors of cardiac events with a hazard ratio of 0.936 and 1.015 (95% confidence interval [CI]: 0.860-0.974, P = 0.006; and 95% CI: 1.003-1.027, P = 0.016), respectively.
The measurement of TS and TWA is useful for assessing risk for rehospitalization and cardiac death in HF patients.
心力衰竭（HF）患者有更高的复发性 HF 和心脏死亡风险，电重构被认为是 HF 进展的重要因素。本研究旨在验证心电图和动态心电图监测在 HF 患者风险分层中的效用。
我们的研究包括 215 名（男 144 名，平均年龄 62 岁）因急性失代偿性 HF 住院的患者。在出院前稳定状态下进行心电图（QRS 持续时间和 QTc 间期）和 24 小时动态心电图监测（心率变异性、心率震荡和 T 波交替[TWA]）。然后调查临床特征和结局。
在中位随访 2.7 年期间，发生 83 例（38.6%）心脏事件（因 HF 恶化而再住院[n=51]或心脏死亡[n=32]）。与无心脏事件的患者相比，发生心脏事件的患者的湍流斜率（TS）较低，TWA 较高（TS，3.0±5.5ms/RR 与 5.3±5.6ms/RR，P=0.001；TWA，66.1±19.6μV 与 54.7±15.1μV，P<0.001）。单变量分析显示，TS、TWA、QRS 持续时间和 QTc 间期与心脏事件相关（P=0.004、P<0.001、P=0.037 和 P=0.024），而多变量分析在调整多个混杂因素后显示，TS 和 TWA 是心脏事件的独立预测因素，风险比分别为 0.936 和 1.015（95%置信区间[CI]：0.860-0.974，P=0.006；和 95%CI：1.003-1.027，P=0.016）。
TS 和 TWA 的测量对于评估 HF 患者再住院和心脏死亡的风险是有用的。
