QT variability index on 24-hour Holter independently predicts mortality in patients with heart failure: analysis of Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca (GISSI-HF) trial

Dobson, Craig P; Rovere, Maria Teresa La; Pinna, Gian Domenico; Goldstein, Robert E.; Olsen, Cara; Bernardinangeli, Marino; Veniani, Marco; Midi, Paolo; Tavazzi, Luigi; Haigney, Mark C.

doi:10.1016/j.hrthm.2011.03.055

Cited by 40 publications

(35 citation statements)

References 18 publications

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“…18,33–36 We assessed all these QT variables because in a large prospective study conducted in recent years the investigators reported that QT e VI is associated with an increased risk of overall mortality during CHF though not specifically related to SCD. 37 Particularly, the pathophysiological meaning of the T e interval remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Myocardial repolarization dispersion and autonomic nerve activity in a canine experimental acute myocardial infarction model

Piccirillo¹,

Moscucci²,

D'Alessandro³

et al. 2014

Heart Rhythm

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Background Evidence from a canine experimental acute myocardial infarction (MI) model shows that until the seventh week after MI the relationship between stellate ganglionic nerve and vagal nerve activities (SGNA/VNA) progressively increases. Objective We evaluated how autonomic nervous system activity influences temporal myocardial repolarization dispersion at this period. Methods We analyzed autonomic nerve activity as well as QT and RR variability from recordings previously obtained in 9 dogs. From a total 48 short-term electrocardiographic segments, 24 recorded before and 24 seven weeks after experimentally-induced MI, we obtained three indices of temporal myocardial repolarization dispersion: QTe (from q wave T to wave end), QTp (from q wave to T wave peak) and Te (from T wave peak to T wave end) variability index (QTeVI, QTpVI, TeVI). We also performed a heart rate variability power spectral analysis on the same segments. Results After MI, all the QT variables increased QTeVI (median [interquartile range]) (from - 1.76[0.82] to −1.32[0.68]), QTeVI (from −1.90[1.01] to −1.45[0.78]) and TeVI (from −0.72[0.67] to −0.22[1.00]), whereas all RR spectral indexes decreased (p<0.001 for all). Distinct circadian rhythms in QTeVI (p<0.05,) QTpVI (p<0.001) and TeVI (p<0.05) appeared after MI with circadian variations resembling that of SGNA/VNA. The morning QTpVI and TeVI acrophases approached the SGNA/VNA acrophase. Conversely, the evening QTeVI acrophase coincided with another SGNA/VNA peak. After MI, regression analysis detected a positive relationship between SGNA/VNA and TeVI (R2: 0.077; β: 0.278; p< 0.001). Conclusion Temporal myocardial repolarization dispersion shows a circadian variation after MI reaching its peak at a time when sympathetic is highest and vagal activity lowest.

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Section: Discussionmentioning

confidence: 99%

Myocardial repolarization dispersion and autonomic nerve activity in a canine experimental acute myocardial infarction model

Piccirillo¹,

Moscucci²,

D'Alessandro³

et al. 2014

Heart Rhythm

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“…Increased QT variability is associated with increased mortality in patients with heart failure and with increased risk of ventricular tachycardia and ventricular fibrillation (Haigney et al., 2004; Dobson et al., 2011). These studies analyzed temporal variability of repolarization from single channel ECG data.…”

Section: Discussionmentioning

confidence: 99%

Seizure-related cardiac repolarization abnormalities are associated with ictal hypoxemia

et al. 2011

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Summary Purpose Cardiac arrhythmias and respiratory disturbances have been proposed as likely causes for sudden unexpected death in epilepsy. Oxygen desaturation occurs in one-third of patients with localization-related epilepsy (LRE) undergoing inpatient video-EEG telemetry (VET) as part of their pre-surgical workup. Ictal-related oxygen desaturation is accompanied by hypercapnia. Both abnormal lengthening and shortening of the corrected QT interval (QTc) on the electrocardiogram (EKG) have been reported with seizures. QTc abnormalities are associated with increased risk of sudden cardiac death. We hypothesized that there may be an association between ictal hypoxemia and cardiac repolarization abnormalities. Methods VET data from patients with refractory LRE were analyzed. Consecutive patients having at least one seizure with accompanying oxygen desaturation below 90% and artifact free EKG data were selected. EKG during the one minute prior to seizure onset (PRE) and during the ictal/postictal period with accompanying oxygen desaturation below 90%(DESAT) was analyzed. Consecutive QT and RR intervals were measured. In the same patients, DESAT seizures were compared with seizures without accompanying oxygen desaturation below 90% (NODESAT). For NODESAT seizures, QT and RR intervals for 2 minutes after seizure onset were measured. Key findings 37 DESAT seizures were analyzed in 17 patients with localization-related epilepsy. A total of 2448 QT and RR intervals were analyzed during PRE. During DESAT, 1554QT and RR intervals were analyzed. 12 of the 17patients had at least one NODESAT seizure. A total of 19 NODESAT seizures were analyzed, including 1558 QT and RR intervals during PRE and 3408 QT and RR intervals during NODESAT. The odds ratio for an abnormally prolonged (>457 msec) QTcH (Hodges correction method) during DESAT relative to PRE was 10.64(p<0.0001). The odds ratio for an abnormally shortened (<372 msec) QTcH during DESAT relative to PRE was 1.65 (p<0.0001). Seizure-related shortening and prolongation of QTc during DESAT were also observed when Fridericia correction of the QT was applied. During DESAT seizures, the mean range of QT values (QTr)(61.14 msec) was significantly different from that during PRE (44.43 msec) (p=0.01). There was a significant association between DESAT QTr and oxygen saturation nadir (p=0.025) and between DESAT QTr and duration of oxygen desaturation (p < 0.0001). Both QTcH prolongation and shortening also occurred with NODESAT seizures. A seizure-associated prolonged QTcH was more likely during DESAT than NODESAT with an odds-ratio of 4.30 (p<0.0001). A seizure-associated shortened QTcH was more likely during DESAT than NODESAT with an odds-ratio of 2.13 (p<0.0001). Significance We have shown that the likelihood of abnormal QTcH prolongation is increased 4.3-fold with seizures that are associated with oxygen desaturation when compared with seizures that are not accompanied with oxygen desaturation. The likelihood of abnormally shortened QTcH increases with seizures that ar...

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“…Data were sampled at a frequency of 1000 Hz . Generated ECG recordings were manually screened for clinically relevant abnormalities and analyzed using a MATLAB‐based program . High‐frequency HRV was derived as power amplitude in the spectrum between 0.15–0.40 Hz generated by a fast‐Fourier transformation.…”

Section: Methodsmentioning

confidence: 99%

Real‐time assessment of heart rate variability and loss of control eating in adolescent girls: A pilot study

Ranzenhofer

Engel

Crosby

et al. 2015

Intl J Eating Disorders

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Objective Studying physiologic underpinnings of loss-of-control (LOC) eating may inform its etiology and contribute to intervention efforts. We therefore examined temporal relationships between autonomic indices (heart rate (HR), heart rate variability (HRV)) and LOC-eating in the natural environment. Method For two days, adolescents (n=17, 14.77±1.55 years, BMI-Z 2.17±0.48) with LOC-eating reported on LOC using an electronic device while HR and HRV were assessed continuously using Holter monitoring. Results Higher HR and lower HRV in the 30-minutes before eating were significantly associated with LOC-eating overall (p’s < 0.001) and at the within-subjects level (p’s < 0.001), but not at the between-subjects level (p’s > 0.44). Examined categorically, HR was significantly higher, and HRV significantly lower, prior to high-LOC compared to low-LOC episodes (p’s < 0.001). Discussion This pilot study suggests that LOC-eating may involve physiologic underpinnings. Additional research with larger samples is needed to further investigate this phenomenon.

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QT variability index on 24-hour Holter independently predicts mortality in patients with heart failure: analysis of Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca (GISSI-HF) trial

Cited by 40 publications

References 18 publications

Myocardial repolarization dispersion and autonomic nerve activity in a canine experimental acute myocardial infarction model

Myocardial repolarization dispersion and autonomic nerve activity in a canine experimental acute myocardial infarction model

Seizure-related cardiac repolarization abnormalities are associated with ictal hypoxemia

Real‐time assessment of heart rate variability and loss of control eating in adolescent girls: A pilot study

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