Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States of America.
University of Colorado Division of Cardiology, Aurora, CO, United States of America.
Int J Cardiol. 2020 Feb 15;301:147-151. doi: 10.1016/j.ijcard.2019.08.048. Epub 2019 Aug 26.
Heart failure (HF) with recovered ejection fraction (HFrecEF) is an increasingly recognized yet not well understood phenotype. Little is known about electrical parameters associated with myocardial recovery in acute systolic HF.
We identified a subset of 87 patients from a non-ischemic cardiomyopathy cohort with left ventricular ejection fraction (LVEF) < 40% during index HF hospitalization. HFrecEF was defined as follow-up LVEF ≥40% and ≥ 10% improvement from baseline. We analyzed baseline and follow up electrocardiograms (ECG) in this group for several electrical parameters known to reflect repolarization heterogeneity.
Among 87 patients, 30 (34%) patients recovered in a median of 122 (IQR: 58-275) days after index hospitalization. Baseline demographics were similar among HFrecEF versus persistent HFrEF except for increased diabetes in the persistent HFrEF cohort. Patients with HFrecEF had baseline decreased QRST angle, decreased QT dispersion, and less negative signed JT area compared to persistent HFrEF. Patients with HFrecEF had greater decrease in QT dispersion and QTc duration, and greater increase in the signed JT and TpTe areas over time. Baseline QRST angle correlated with longitudinal and circumferential strain and myocardial systolic performance (MSP). Signed JT area correlated with increased baseline LVEF, smaller baseline LV dimensions, increased longitudinal and circumferential strain, and MSP. Signed TpTe correlated with increased longitudinal and circumferential strain, and MSP.
Several conventional and novel ECG parameters that reflect repolarization heterogeneity may differentiate patients with acute HF who ultimately recover LVEF. These parameters are associated with baseline structural parameters and are dynamic during recovery.
射血分数恢复的心衰（HFrecEF）是一种越来越被认识但尚未被充分了解的表型。对于急性收缩性心衰中心肌恢复与电参数的相关性知之甚少。
我们从左心室射血分数（LVEF）<40%的非缺血性心肌病队列中确定了 87 例亚组患者。HFrecEF 定义为随访 LVEF≥40%和较基线至少提高 10%。我们分析了这组患者的基线和随访心电图（ECG），以了解反映复极异质性的几个电参数。
在 87 例患者中，30 例（34%）患者在指数住院后中位数 122（IQR：58-275）天内恢复。HFrecEF 与持续性 HFrEF 患者的基线人口统计学特征相似，但持续性 HFrEF 患者的糖尿病发病率较高。与持续性 HFrEF 相比，HFrecEF 患者的基线 QRST 角减小、QT 离散度减小和负性 JT 面积减小。HFrecEF 患者的 QT 离散度和 QTc 持续时间随时间增加而减少，JT 和 TpTe 面积的符号增加。基线 QRST 角与纵向和周向应变及心肌收缩性能（MSP）相关。符号 JT 面积与基线 LVEF 增加、基线 LV 尺寸减小、纵向和周向应变增加以及 MSP 相关。符号 TpTe 与纵向和周向应变以及 MSP 相关。
反映复极异质性的几个传统和新型 ECG 参数可区分最终恢复 LVEF 的急性心衰患者。这些参数与基线结构参数相关，并在恢复过程中具有动态变化。
