Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients

Saúl Palacios,Esther Pueyo,Iwona Cygankiewicz,Juan Pablo Martínez,Antoni Bayés De Luna

doi:10.1038/s41598-021-99861-1

Abstract

The two most common modes of death among chronic heart failure (CHF) patients are sudden cardiac death (SCD) and pump failure death (PFD). Periodic repolarization dynamics (PRD) quantifies low-frequency oscillations in the T wave vector of the electrocardiogram (ECG) and has been postulated to reflect sympathetic modulation of ventricular repolarization. This study aims to evaluate the prognostic value of PRD to predict SCD and PFD in a population of CHF patients. 20-min high-resolution (1000 Hz) ECG recordings from 569 CHF patients were analyzed. Patients were divided into two groups, hbox {PRD}^+ and hbox {PRD}^-, corresponding to PRD values above and below the optimum cutoff point of PRD in the study population. Univariate Cox regression analysis showed that SCD risk in the hbox {PRD}^+ group was double the risk in the hbox {PRD}^- group [hazard ratio (95% CI) 2.001 (1.127–3.554), hbox {p}<0.05]. The combination of PRD with other Holter-based ECG indices, such as turbulence slope (TS) and index of average alternans (IAA), improved SCD prediction by identifying groups of patients at high SCD risk. PFD could be predicted by PRD only when combined with TS [hazard ratio 2.758 (1.572–4.838), hbox {p}<0.001]. In conclusion, the combination of PRD with IAA and TS can be used to stratify the risk for SCD and PFD, respectively, in CHF patients.

Highlights

The two most common modes of death among chronic heart failure (CHF) patients are sudden cardiac death (SCD) and pump failure death (PFD)
The study population consisted of 569 CHF patients (409 men and 160 women), aged 20–80 years, enrolled in the MUSIC (MUerte Subita en Insuficiencia Cardiaca) study
Periodic repolarization dynamics (PRD) has been previously used in various contexts[19,27,30,31,32,33,34], in this study, we computed PRD in a large CHF cohort to predict the risk of the two most common modes of death, namely SCD and PFD, both considering PRD on its own and in combination with other ECG-based indices

Summary

Introduction

The two most common modes of death among chronic heart failure (CHF) patients are sudden cardiac death (SCD) and pump failure death (PFD). The combination of PRD with other Holter-based ECG indices, such as turbulence slope (TS) and index of average alternans (IAA), improved SCD prediction by identifying groups of patients at high SCD risk. SCD is defined as death due to unexpected circulatory arrest that occurs within an hour of the onset of symptoms or during s leep[9] Another common cause of death in CHF is pump failure death (PFD), resulting from progressive pump failure. Treatment with β-blockers and implantable cardioverter defibrillators (ICDs) are effective therapies for prevention of SCD, improving the quality of life of affected patients and altering the mode of death from SCD to P FD10 Based on this evidence, there is an important need to successfully predict the mode of death in CHF, which could contribute to a more cost-effective use of medications or devices

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