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

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).

Glucose dysregulation and repolarization variability markers are short-term mortality predictors in decompensated heart failure

“…For these reasons, we believe that elevated fasting glucose level and an increase of Te mean could be also considered a simple noninvasive marker of short-period mortality in acutely decompensated patients. In previous studies, both fasting glucose [16] and Te mean [4–6] were significantly associated with short-period mortality in this kind of CHF subjects; the novelty of the present study was the evidence that these two studied variables mutually increased their predictive power. Whereas we do not know if these two variables are merely mortality risk markers or if they even have a causal role, however, the link between these two variables should be sought in the combination of frequent diabetes complications and pathophysiological CHF derangement.…”

“…In particular, the II ECG lead recordings, the same used in our study, could represent a marker of apicobasal and interventricular repolarization myocardial dispersion rather than transmural [24]. However, whatever the genesis of this parameter could be, Te remains a powerful predictive marker of total and cardiovascular mortality [4–8] and not a mere marker of sudden cardiac death.…”

“…We recorded 5 min of II lead ECG (Miocardio Event, Rome, Italy), and the signals were acquired, digitalized at a sampling frequency of 500 Hz, and wirelessly transmitted to a cloud platform for the data storage via mobile phone [4][5][6]. Subsequently, all digitized signal recordings were downloaded by the cloud platform and automatically analyzed, and checked by a single physician blinded to subjects' circumstances.…”

“…could be used to stratify the 30-day mortality risk in decompensated CHF subjects. In particular, we recently observed that an increase of Tpeak-Tend interval (Te), obtained during 5-min ECG recoding, was able to stratify the short-period mortality risk in this kind of patients [4][5][6]. Previously, in a meta-analysis based on patients with different cardiovascular risk profiles [7] and in a large longitudinal epidemiologic study [8], an increased risk of cardiovascular mortality, sudden arrhythmic death and total mortality associated with a Te increase were reported.…”

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

“…Several works have proposed other markers related to repolarization variability measured from short-term ECG recordings, such as the variance normalized by the mean of QT end, QT peak or T-peak-to-T-end (Te) intervals, and have evaluated them in CHF populations. In recent studies, the mean and/or standard deviation of Te have been shown to predict 30-day mortality 58 , 59 and mortality in hospital 60 among decompensated CHF patients.…”