Combined evaluation of ambulatory‐based late potentials and nonsustained ventricular tachycardia to predict arrhythmic events in patients with previous myocardial infarction: A Japanese noninvasive electrocardiographic risk stratification of sudden cardiac death (JANIES) substudy

Abstract

Background Noninvasive electrocardiographic (ECG) markers are promising arrhythmic risk stratification tools for identifying sudden cardiac death. However, little is known about the usefulness of noninvasive ECG markers derived from ambulatory ECGs (AECG) in patients with previous myocardial infarction (pMI). We aimed to determine whether the ECG markers derived from AECG can predict serious cardiac events in patients with pMI. Methods We prospectively analyzed 104 patients with pMI (88 males, age 66 ± 11 years), evaluating late potentials (LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT) derived from AECG. The primary endpoint was the documentation of ventricular fibrillation or sustained ventricular tachycardia. Results Eleven patients reached the primary endpoint during a follow‐up period of 25 ± 9.5 months. Of the 104 patients enrolled in this study, LP positive in worst values (w‐LPs) and NSVT were observed in 25 patients, respectively. In the arrhythmic event group, the worst LP values and/or NSVT were found in eight patients (7.6%). The positive predictive and negative predictive values of the combined assessment with w‐LPs and NSVT were 56% and 94%, respectively, for predicting ventricular lethal arrhythmia. Kaplan–Meier analysis demonstrated that the combination of w‐LPs and NSVT had a poorer event‐free period than negative LPs (p < .0001). In the multivariate analysis, the combined assessment of w‐LPs and NSVT was a significant predictor of arrhythmic events (hazard ratio = 14.1, 95% confidence intervals: 3.4–58.9, p < .0001). Conclusion Combined evaluation of w‐LPs and NSVT was a powerful risk stratification strategy for predicting arrhythmia that can lead to sudden cardiac death in patients with pMI.

Ambulatory electrocardiographic markers predict serious cardiac events in patients with chronic kidney disease: The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Disease (JANIES‐CKD) study

“…Ambulatory‐based LPs were considered positive on fulfillment of two of the following three criteria: fQRS > 135 ms, RMS 40 < 15 μV, and LAS 40 > 39 ms (Abe et al, 2012). The worst values for a‐LPs (w‐LPs) were calculated and used for analysis in this study according to a previously published method (Hashimoto et al, 2020; Kinoshita et al, 2020). W‐LPs were defined as measurements detected when the RMS 40 was the smallest over 24 h.…”

“…Ambulatory-based LPs were considered positive on fulfillment of two of the following three criteria: fQRS > 135 ms, RMS 40 < 15 μV, and LAS 40 > 39 ms (Abe et al, 2012). The worst values for a-LPs (w-LPs) were calculated and used for analysis in this F I G U R E 1 Studypopulation.PatientswereenrolledfromApril2012toMarch2015.Follow-updatacollectionwasperformedevery 6monthsuntilSeptember2015.CKD,chronickidneydisease;JANIES-CKD,TheJapaneseNoninvasiveElectrocardiographicRisk Stratification of Sudden Cardiac Death in Chronic Kidney Disease; SHD, structural heart disease study according to a previously published method (Hashimoto et al, 2020;Kinoshita et al, 2020). W-LPs were defined as measurements detected when the RMS 40 was the smallest over 24 h.…”

“…It has been reported that noninvasive electrocardiographic markers (NIEMs), including late potentials (LPs) (Gatzoulis et al, 2018), heart rate turbulence (HRT) (Bauer et al, 2008), and nonsustained ventricular tachycardia (NSVT) (Kinoshita et al, 2020), are useful predictors of lethal arrhythmic events and SCD in patients with SHD. We have recently demonstrated that a combined assessment of NIEMs obtained from high‐resolution digital electrocardiogram (ECG) systems accurately predicts the occurrence of lethal arrhythmias and SCD in patients with SHD (Hashimoto et al, 2020; Kinoshita et al, 2020). Although LPs have been associated with mortality and SCD in patients with end‐stage renal disease (Morales et al, 1998), little is known about the usefulness of other NIEMs in predicting lethal arrhythmias or cardiac mortality in patients with CKD, regardless of disease severity or the presence of concurrent SHD.…”

Clinical Predictors of Occurrence of Ventricular Tachyarrhythmias in Patients with Reduced Left Ventricle Ejection Fraction. Results of Single-Center Prospective Study

“…[16] пришли к выводу, что неустойчивые ЖТ, зарегистрированные у больных, перенесших инфаркт миокарда (ИМ), имеют независимое прогностическое значение относи-тельно будущих исходов аритмии (ОШ 3,6; 95 % ДИ 1,6-11,2; р=0,027). В случае регистрации этих нарушений ритма и выявления на ЭКГ «поздних» потенциалов риск развития ЖА увеличивался еще почти в 4 раза (ОШ 14,1; 95 % ДИ 3,4-58,9; р<0,0001) [16]. Сходные выводы были сделаны и относительно пациентов с НКМП [12].…”

Association of non‐invasive electrocardiographic risk factors with left ventricular systolic function in post‐myocardial infarction patients with mildly reduced or preserved ejection fraction: Insights from the PRESERVE‐EF study

“…with a history of sustained monomorphic VT (Gatzoulis et al, 2018;Hashimoto et al, 2021). Although their positive predictive value in these patients is far from ideal, they have a very good negative predictive value in the post-MI setting and also, they seem to be useful when incorporated in multifactorial risk stratification algorithms (Gatzoulis et al, 2018).…”