Predicting arrhythmias in primary prevention heart failure patients: picking up the fragments

Engstrom, Nathan; Letson, Hayley L.; Ng, Kevin; Dobson, Geoffrey P.

doi:10.1136/openhrt-2022-002075

Cited by 2 publications

(4 citation statements)

References 18 publications

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“…fQRS is an ECG abnormality associated with myocardial scarring and fibrosis. Consequently, its presence has been correlated in previous studies with a higher risk of ventricular arrhythmias, sudden cardiac death and all-cause mortality [ 11 , 90 , 91 , 92 , 93 , 94 ]. The relationship between spot UNa and fQRS highlights the value of spot UNa as a prognostic biomarker that can predict the risk of ventricular arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

ECG and Biomarker Profile in Patients with Acute Heart Failure: A Pilot Study

et al. 2022

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Background: Biomarkers, electrocardiogram (ECG) and Holter ECG are basic, accessible and feasible cardiac investigations. The combination of their results may lead to a more complex predictive model that may improve the clinical approach in acute heart failure (AHF). The main objective was to investigate which ECG parameters are correlated with the usual cardiac biomarkers (prohormone N-terminal proBNP, high-sensitive cardiac troponin I) in patients with acute heart failure, in a population from Romania. The relationship between certain ECG parameters and cardiac biomarkers may support future research on their combined prognostic value. Methods: In this prospective case-control study were included 49 patients with acute heart failure and 31 participants in the control group. For all patients we measured levels of prohormone N-terminal proBNP (NT-proBNP), high-sensitive cardiac troponin I (hs-cTnI) and MB isoenzyme of creatine phosphokinase (CK-MB) and evaluated the 12-lead ECG and 24 h Holter monitoring. Complete clinical and paraclinical evaluation was performed. Results: NT-proBNP level was significantly higher in patients with AHF (p < 0.001). In patients with AHF, NT-proBNP correlated with cQTi (p = 0.027), pathological Q wave (p = 0.029), complex premature ventricular contractions (PVCs) (p = 0.034) and ventricular tachycardia (p = 0.048). Hs-cTnI and CK-MB were correlated with ST-segment modification (p = 0.038; p = 0.018) and hs-cTnI alone with complex PVCs (p = 0.031). Conclusions: The statistical relationships found between cardiac biomarkers and ECG patterns support the added value of ECG in the diagnosis of AHF. We emphasize the importance of proper ECG analysis of more subtle parameters that can easily be missed. As a non-invasive technique, ECG can be used in the outpatient setting as a warning signal, announcing the acute decompensation of HF. In addition, the information provided by the ECG complements the biomarker results, supporting the diagnosis of AHF in cases of dyspnea of uncertain etiology. Further studies are needed to confirm long-term prognosis in a multi-marker approach.

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Section: Discussionmentioning

confidence: 99%

ECG and Biomarker Profile in Patients with Acute Heart Failure: A Pilot Study

et al. 2022

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“…B Different morphologies of fragmented QRS complexes (fQRS) in the 12-lead ECG by Das et al [ 18 ] and modified fQRS Q, R and S criteria after Haukilahti et al [ 2 ]. Modified after Engstrom et al [ 20 ] …”

Section: Ventriculo-arterial Coupling As An Improved Measure Of Mecha...mentioning

confidence: 99%

“…In a recent review we showed fQRS was associated with ventricular arrhythmias and all-cause mortality in primary prevention HF patients indicated for ICD implantation [ 3 ]. fQRS is the zig-zag notching and slurring of the QRS complex that indicates myocardial scarring and fibrosis [ 2 , 20 ] (Fig. 1 B).…”

Section: Assessing Non-viable Myocardium and Arrhythmogenic Substratementioning

confidence: 99%

“…The size and location of scar or fibrotic region can further be quantified using late gadolinium enhancement cardiac magnetic resonance imaging (Ga-MRI) [ 4 ] or myocardial perfusion-gated scintigraphy (SPECT) [ 21 ]. Moreover, the different forms of fQRS in HF patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM) may be useful to predict different left ventricular remodelling, conduction defects and active arrhythmogenic substrate [ 2 , 20 ], which may also be used for personalization of treatment. In summary, we hypothesize VA coupling and fQRS in high-risk HF patients may provide a superior prognostic measure of (1) cardiovascular function; (2) active arrhythmogenic substrate; and (3) SCD, compared to LVEF and HF symptoms.…”

Section: Assessing Non-viable Myocardium and Arrhythmogenic Substratementioning

confidence: 99%

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Ventriculo-arterial (VA) coupling and fQRS as new selection criteria for primary prevention ICD placement

Engstrom,

Letson,

et al. 2024

ICMx

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For decades, left ventricular ejection fraction (LVEF < 35%) has been a mainstay for identifying heart failure (HF) patients most likely to benefit from an implantable cardioverter defibrillator (ICD). However, LVEF is a poor predictor of sudden cardiac death (SCD) and ignores 50% of HF patients with mildly reduced and preserved LVEF. The current international guidelines for primary prophylaxis ICD therapy are inadequate. Instead of LVEF, which is not a good measure of LV contractility or hemodynamic characterization, we hypothesize ventriculo-arterial (VA) coupling combined with fragmented QRS (fQRS) will improve risk stratification and patient suitability for an ICD. Quantifying cardiac and aortic mechanics, and predicting active arrhythmogenic substrate, from varying fQRS morphologies, may help to stratify ischemic and non-ischemic patients with different functional capacities and predisposition for lethal arrhythmias. We propose HF patients with a low physiological reserve may not benefit from ICD therapy, whereas those patients with higher reserves and extensive arrhythmogenic substrate may benefit. Our hypothesis combining VA coupling with fQRS changes has the potential to widen HF patient participation (low and high LVEF) and advance personalized medicine for HF patients at high risk of SCD.

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Predicting arrhythmias in primary prevention heart failure patients: picking up the fragments

Cited by 2 publications

References 18 publications

ECG and Biomarker Profile in Patients with Acute Heart Failure: A Pilot Study

ECG and Biomarker Profile in Patients with Acute Heart Failure: A Pilot Study

Ventriculo-arterial (VA) coupling and fQRS as new selection criteria for primary prevention ICD placement

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