First Department of Cardiology and Electrophysiology Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Arsenos Heart and Biosignals Lab., Avlonas, Attica, Greece.
First Department of Cardiology and Electrophysiology Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
J Electrocardiol. 2022 May-Jun;72:109-114. doi: 10.1016/j.jelectrocard.2022.03.013. Epub 2022 Apr 8.
Prolonged repolarization duration is a significant total mortality (TM) predictor in post-myocardial infarction patients.
We examined the clinical significance of QT interval that was extracted from a Short Resting Holter ECG (SRH ECG - 30-min duration) as a TM predictor in heart failure (HF) patients.
One hundred forty-five HF patients (male = 84%, mean age = 64 ± 12 years, mean LVEF = 33 ± 10%) underwent an SRH ECG recording for 30 min. These high-resolution ECG signals were analyzed and the QT interval was calculated and corrected according to the Fridericia formula. After 42.1 months, 26 patients died.
Univariate analysis for Deceased and Living groups: QTc:455 ± 33 ms vs 441 ± 32 ms (p = 0.04), LVEF:32 ± 10% vs 34 ± 9% (p < 0.5), Mean Heart Rate: 73 ± 11 bpm vs 69 ± 12 bpm (p = 0.2), SDNN/HRV: 45 ± 42 ms vs 41 ± 29 ms (p = 0.4), QRS: 123 ± 26 ms vs 119 ± 29 ms (p = 0.5). Multivariate Cox regression analysis with model adjusted for QTc, Mean Heart Rate, LVEF, QRS, revealed that QTc-Fridericia interval was an independent TM predictor (H.R.:1.017, 95% C.I.: 1.003-1.030, p = 0.01). The cut-off point of 490 ms (90th percentile) in the same model presented HR: 2.9 for TM (95%C.I.: 1.066-7.882, p = 0.03). Kaplan Meier curves depicted a clear difference in survival between the two patients' groups (QTc Group≥490 ms vs QTc Group <490 ms). The curve diverge was important (log-rank, p = 0.02).
A fast risk stratification approach with SRH ECG recording is an efficient method for flash evaluation of mortality risk in HF patients.
延长的复极时间是心肌梗死后患者总死亡率（TM）的重要预测指标。
我们研究了从短休息动态心电图（SRH ECG-30 分钟持续时间）提取的 QT 间期作为心力衰竭（HF）患者 TM 预测指标的临床意义。
145 例 HF 患者（男性占 84%，平均年龄 64±12 岁，平均左心室射血分数[LVEF]为 33±10%）接受了 30 分钟的 SRH ECG 记录。对这些高分辨率心电图信号进行了分析，并根据 Fridericia 公式计算和校正了 QT 间期。42.1 个月后，26 名患者死亡。
对死亡组和存活组进行单变量分析：QTc：455±33ms 与 441±32ms（p=0.04），LVEF：32±10%与 34±9%（p<0.5），平均心率：73±11bpm 与 69±12bpm（p=0.2），SDNN/HRV：45±42ms 与 41±29ms（p=0.4），QRS：123±26ms 与 119±29ms（p=0.5）。多变量 Cox 回归分析，模型中调整了 QTc、平均心率、LVEF、QRS，表明 Fridericia 校正 QT 间期是 TM 的独立预测因子（HR：1.017，95%CI：1.003-1.030，p=0.01）。同一模型中 490ms（第 90 百分位数）的截断点在 TM 时的 HR：2.9（95%CI：1.066-7.882，p=0.03）。Kaplan-Meier 曲线描绘了两组患者之间生存的明显差异（QTc 组≥490ms 与 QTc 组<490ms）。曲线分歧很重要（对数秩检验，p=0.02）。
使用 SRH ECG 记录进行快速风险分层方法是评估 HF 患者死亡率风险的有效方法。
