Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure.

Gianfranco Piccirillo,Andrea Corrao,Teresa Sabatino,Giulia Zaccagnini,Gaetano Bertani,Damiano Magrì,Fabiola Mastropietri,Davide Crapanzano,Pietro Rossi,Ilaria Di Diego,Marcella Fabietti,Federica Moscucci,Ilaria Lospinuso

doi:10.3390/jcm9061879

Abstract

Background and Objectives: Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values. Method: One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN). Results: Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTeSD (p < 0.01), QTpSD (p < 0.05), mean Te (p < 0.05), TeSD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only TeSD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTeSD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for TeSD (AUC: 0.736, p < 0.001) and QTeSD (AUC: 0.696, p < 0.01). Conclusion: Both mean Te and TeSD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162).

Highlights

The markers of the temporal dispersion of the myocardial repolarization phase have been shown to able to identify those heart failure (HF) patients at high risk, either in terms of all-cause mortality [1,2] or sudden cardiac death due to malignant ventricular arrhythmias [2,3,4]
Changes in the electrocardiographic (ECG)-derived variables associated with the myocardial repolarization phase might be extremely useful as immediate markers of complex structural and molecular mechanisms leading to clinical decompensation, as well as possibly lethal arrhythmic complications [24]
Due to the well-known role of the plasmatic levels of N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) in identifying those HF patients at high risk, we evaluated the ability of the temporal dispersion of myocardial repolarization to identify those decompensated HF patients with the highest NT-proBNP values defined according to an arbitrary cutoff value corresponding to the 75th percentile

Summary

Introduction

The markers of the temporal dispersion of the myocardial repolarization phase have been shown to able to identify those heart failure (HF) patients at high risk, either in terms of all-cause mortality [1,2] or sudden cardiac death due to malignant ventricular arrhythmias [2,3,4]. Changes in the electrocardiographic (ECG)-derived variables associated with the myocardial repolarization phase might be extremely useful as immediate markers of complex structural and molecular mechanisms leading to clinical decompensation, as well as possibly lethal arrhythmic complications [24]. These non-invasive and relatively easy to obtain ECG-derived data, in a setting of increasingly ageing population with many comorbidities, could represent a useful tool in the management of chronic patients in the contexts of non-intensive care, institutionalization or even at home. Larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162)

Methods

Results

Conclusion