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Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients
Author(s) -
Yamada Shinya,
Yoshihisa Akiomi,
Sato Yu,
Sato Takamasa,
Kamioka Masashi,
Kaneshiro Takashi,
Oikawa Masayoshi,
Kobayashi Atsushi,
Suzuki Hitoshi,
Ishida Takafumi,
Takeishi Yasuchika
Publication year - 2018
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13639
Subject(s) - heart rate turbulence , medicine , cardiology , t wave alternans , hazard ratio , qrs complex , heart failure , sudden cardiac death , qt interval , confounding , confidence interval , heart rate , heart rate variability , blood pressure
Background Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of HF patients. Methods Our study comprised 215 patients (144 males, mean age 62 years) who had been hospitalized due to acute decompensated HF. Electrocardiogram (QRS duration and QTc interval) and 24‐hour Holter monitoring (heart rate variability, heart rate turbulence, and T‐wave alternans [TWA]) were performed in stable condition before discharge. The clinical characteristics and outcomes were then investigated. Results During a median follow‐up period of 2.7 years, there were 83 (38.6%) cardiac events (rehospitalization due to worsening HF [n = 51] or cardiac death [n = 32]). The patients with cardiac events had a lower turbulence slope (TS) and higher TWA compared to those without cardiac events (TS, 3.0 ± 5.5 ms/RR vs. 5.3 ± 5.6 ms/RR, P = 0.001; TWA, 66.1 ± 19.6 μV vs. 54.7 ± 15.1 μV, P < 0.001). Univariable analysis showed that TS, TWA, QRS duration, and QTc interval were associated with cardiac events (P = 0.004, P < 0.001, P = 0.037, and P = 0.024, respectively), while the multivariable analysis after the adjustment of multiple confounders showed that TS and TWA were independent predictive factors of cardiac events with a hazard ratio of 0.936 and 1.015 (95% confidence interval [CI]: 0.860–0.974, P = 0.006; and 95% CI: 1.003–1.027, P = 0.016), respectively. Conclusion The measurement of TS and TWA is useful for assessing risk for rehospitalization and cardiac death in HF patients.