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

Abstract

The two most common modes of death among chronic heart failure (CHF) patients are sudden cardiac death (SCD) and pump failure death (PFD). Periodic repolarization dynamics (PRD) quantifies low-frequency oscillations in the T wave vector of the electrocardiogram (ECG) and has been postulated to reflect sympathetic modulation of ventricular repolarization. This study aims to evaluate the prognostic value of PRD to predict SCD and PFD in a population of CHF patients. 20-min high-resolution (1000 Hz) ECG recordings from 569 CHF patients were analyzed. Patients were divided into two groups, $$\hbox {PRD}^+$$ PRD + and $$\hbox {PRD}^-$$ PRD - , corresponding to PRD values above and below the optimum cutoff point of PRD in the study population. Univariate Cox regression analysis showed that SCD risk in the $$\hbox {PRD}^+$$ PRD + group was double the risk in the $$\hbox {PRD}^-$$ PRD - group [hazard ratio (95% CI) 2.001 (1.127–3.554), $$\hbox {p}<0.05$$ p < 0.05 ]. The combination of PRD with other Holter-based ECG indices, such as turbulence slope (TS) and index of average alternans (IAA), improved SCD prediction by identifying groups of patients at high SCD risk. PFD could be predicted by PRD only when combined with TS [hazard ratio 2.758 (1.572–4.838), $$\hbox {p}<0.001$$ p < 0.001 ]. In conclusion, the combination of PRD with IAA and TS can be used to stratify the risk for SCD and PFD, respectively, in CHF patients.

Electrocardiography Assessment of Sympatico–Vagal Balance during Resting and Pain Using the Texas Instruments ADS1299

“…However, in some cases, the detected T-waves were inaccurate as T-waves, and P-wave amplitudes of V y were too low to be distinguished from each other, or the T-wave inversion in V z was misidentified. Then the T-waves were defined from the detected QRS complex as described in [24]:…”

“…In this study, the phase-rectified signal averaging based PRD calculation was used for the assessment of the PRD in resting and cold pressor conditions as [10,17,24]:…”

T-Wave Analysis on the 24 h Holter ECG Monitoring as a Predictive Assessment of Major Adverse Cardiovascular Events in Patients with Myocardial Infarction: A Literature Review and Future Perspectives

“…The T-wave is an important aspect of the ECG that represents ventricular repolarization, with a standard orientation pattern characterized by inversion in lead aVR and upward deflection in other leads [ 29 , 43 , 44 ]. T-wave morphology on the 12-lead ECG is prognostic for MACE in myocardial infarction, but excessive electrophysiological heterogeneity in the heart can contribute to arrhythmogenesis and SCD [ 45 , 46 , 47 ]. The use of Holter ECG monitoring can reveal this heterogeneity through various methods of T-wave analysis [ 45 , 47 , 48 ].…”

“…T-wave morphology on the 12-lead ECG is prognostic for MACE in myocardial infarction, but excessive electrophysiological heterogeneity in the heart can contribute to arrhythmogenesis and SCD [ 45 , 46 , 47 ]. The use of Holter ECG monitoring can reveal this heterogeneity through various methods of T-wave analysis [ 45 , 47 , 48 ]. As such, it is crucial to evaluate ventricular repolarization anomalies to identify myocardial infarction patients at higher risk of cardiac mortality due to SCD [ 46 ].…”

On the history of vectorcardiography: past, present, future

“…В контексте векторкардиографии зародился ряд новых направлений исследований: периодическая динамика реполяризации [40,41]; синтез ВКГ из одного отведения ЭКГ [42]; привязка ВКГ к структурам сердца на основе пациент-специфических моделей [43].…”