Delayed repolarization and ventricular tachycardia in patients with heart failure and preserved ejection fraction

Abstract

Sudden death is the most common mode of mortality in patients with heart failure and preserved ejection fraction (HFpEF). Ventricular arrhythmias (VA) have been suspected as the etiology but the supporting evidence in patients with HFpEF is scarce. We sought to investigate VA prevalence, and to determine if VA are associated with prolonged repolarization, in patients with HFpEF. In a retrospective case-control study design, Cedars-Sinai patients who underwent prolonged ambulatory electrocardiographic monitoring (Zio Patch) between 2016 and 2018 were screened for a clinical diagnosis of HFpEF. Patients with normal diastolic and systolic function who underwent Zio Patch monitoring were also reviewed as controls. Multivariable logistic regression was used to compare the prevalence of rhythm disturbances in patients with and without HFpEF. Ventricular tachycardia (VT) was more prevalent in patients with HFpEF (37% vs. 16% in controls, p = 0.001). Most episodes were non-sustained except for one case of sustained VT in a patient with HFpEF. Covariate-adjusted logistic regression including HFpEF diagnosis, age, sex, body mass index, and the presence of comorbidities revealed that only HFpEF was associated with increased risk of VT (relative risk 2.86, p = 0.023). Subgroup-analyses revealed an association between increased QTc interval and risk of VT (460 ± 38 ms in HFpEF patients with VT vs. 445 ± 28 ms in HFpEF patients without VT, p = 0.03). Non-sustained VT was more prevalent in patients with HFpEF compared to patients without HFpEF, and QTc interval prolongation was associated with VT in HFpEF.

Sudden Death and Ventricular Arrhythmias in Heart Failure With Preserved Ejection Fraction

“… 37) Covariate-adjusted logistic regression showed that HFpEF was associated with an increased risk of NSVT. 37) Another important prospective observational study was done (VIP-HF study) in the Netherlands for patients with HFpEF using an implantable loop recorder. 38) Eighteen percent of HFpEF patients were shown to have NSVT during the median follow-up of 657 days.…”

“… 36) Most importantly, NSVT was associated with a 3.4-fold increased risk of death in HFpEF patients. 36) A similar retrospective medical record review was done by Cho et al 37) for HFpEF patients who underwent ambulatory Zio patch monitoring. Similarly, NSVT was found in 37% of HFpEF patients, as compared to 16% occurrence in patients without HFpEF.…”

“…Similarly, NSVT was found in 37% of HFpEF patients, as compared to 16% occurrence in patients without HFpEF. 37) Additionally, sustained VT was identified in 1/110 HFpEF patients. 37) Covariate-adjusted logistic regression showed that HFpEF was associated with an increased risk of NSVT.…”

“… 37) Additionally, sustained VT was identified in 1/110 HFpEF patients. 37) Covariate-adjusted logistic regression showed that HFpEF was associated with an increased risk of NSVT. 37) Another important prospective observational study was done (VIP-HF study) in the Netherlands for patients with HFpEF using an implantable loop recorder.…”

“…Delayed repolarization has been a recurrent theme in the pathogenesis of cardiac arrhythmias. 45) 46) Cho et al 37) retrospectively studied 110 HFpEF patients and compared them to 97 patients without HFpEF, and discovered that the QTc interval was prolonged in patients with HFpEF (451±33 ms) as compared to patients without HFpEF (432±29 ms). Wilcox et al 47) studied QTc prolongation in 75 patients with HF and discovered that the QTc interval was associated with diastolic dysfunction.…”