Simultaneous Assessment of T-Wave Alternans and Heart Rate Turbulence on Holter Electrocardiograms as Predictors for Serious Cardiac Events in Patients After Myocardial Infarction

Hoshida, Kyoko; Miwa, Yosuke; Miyakoshi, Mutsumi; Tsukada, Takehiro; Yusu, Satoru; Yoshino, Hideaki; Ikeda, Takanori

doi:10.1253/circj.cj-12-0789

Cited by 45 publications

(43 citation statements)

References 23 publications

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“…When we analysed only TO and TS we stated that there is no significant gender-related difference between women and men in these HRT parameters (TO: -0.6 ± 2.7 vs. -0.7 ± 2.4, p = NS and TS: 5.6 ± 5.6 vs. 6.4 ± 6.7 ms/RR interval, p = NS). Similar conclusions were presented in numerous previous studies in healthy and post-MI patients [4,3,12,[22][23][24][25]. Moreover, Schwab et al…”

Section: Discussionsupporting

confidence: 91%

“…The prognostic value of HRT parameters and their combinations in the prediction of total mortality, cardiac mortality, SCD, and fatal arrhythmic events in patients after MI is well-documented [2,[4][5][6][7][8][9][10]. In many published studies, HRT was investigated only in terms of such parameters (as their combinations) as turbulence onset (TO) or turbulence slope (TS), and very little attention in the literature has been paid to evaluate turbulence timing (TT) [5,11,12].…”

Section: Introductionmentioning

confidence: 99%

“…low LVEF, QRS duration, advanced age, arrhythmias), the analysis of HRT is also a powerful predictor of mortality and MACE in patients after MI [2,[4][5][6]13].…”

Section: Introductionmentioning

confidence: 99%

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Gender-dependent profile of heart rate turbulence parameters in patients after acute myocardial infarction treated invasively

et al. 2016

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A b s t r a c t Background and aim:The aim of this study was to determine whether gender is related to differences in heart rate turbulence (HRT) parameters and the authors' own predefined HRT categories comprising turbulence timing (TT) in patients at the early stage of acute myocardial infarction (AMI) treated invasively. Methods:We analysed 489 consecutive patients (147 females and 342 males, aged 63.9 ± 11.7 years) with AMI admitted to our department and treated invasively on admission to the hospital. On the fifth day after MI 24-h digital Holter recordings were performed to assess HRT, and the following HRT parameters were calculated in all patients using the HRTView program: turbulence onset (TO, %), slope (TS, ms/RR interval), and TT. The following values of HRT parameters were considered abnormal: TO ≥ 0, TS ≤ 2.5, and TT ≥ 10. Based on the abovementioned parameters, the authors defined their own HRT categories (A, B, C): A -comprising three normal parameters, B -one abnormal parameter, C -three abnormal parameters. Results:TT was significantly later in women than in men: 7.5 ± 3.1 vs. 6.8 ± 3.1 (p < 0.05), respectively. When analysing the authors' own predefined HRT categories, significant differences between women and men were present in the occurrence of the category C, including all three abnormal HRT parameters: TO, TS, and TT. Conclusions:In women worse TT was present and all three abnormal HRT parameters occurred more frequently. HRT in women after AMI is profoundly altered compared to in men. This indicates greater autonomic dysfunction and higher risk for sudden cardiac death in women after AMI.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Gender-dependent profile of heart rate turbulence parameters in patients after acute myocardial infarction treated invasively

et al. 2016

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“…[12] Despite the fact that these studies had relatively long follow-ups (1.5 to 4 years) and the number of patients (173 to 322), included patients early after MI, differences in mTWA measurement and cut-off values, [19,20] their findings of high prognostic significance of HRT 2 + mTWA confirm our data. Our study was the first one that used DC in a combined assessment of the risk of adverse outcomes and had the long follow-up up to 5 years.…”

Section: Figure 3bsupporting

confidence: 76%

“…Combined risk assessment with HRT and mTWA was first used by the REFINE study authors, [14] and subsequently by the other two study groups [19,20] published later than our 12-months results. [12] Despite the fact that these studies had relatively long follow-ups (1.5 to 4 years) and the number of patients (173 to 322), included patients early after MI, differences in mTWA measurement and cut-off values, [19,20] their findings of high prognostic significance of HRT 2 + mTWA confirm our data.…”

Section: Figure 3bmentioning

confidence: 83%

Long-term Non-Invasive ECG-based Risk Stratification of Sudden Cardiac Death: Extended 5-year Results

Окишева

Царегородцев

Sulimov

2017

ICFJ

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Objectives: To evaluate predictive value of heart rate turbulence (HRT), deceleration capacity (DC) and microvolt T-wave alternans (mTWA) for risk stratification for sudden cardiac death (SCD) in patients after myocardial infarction (MI) during 60 months of follow-up.Methods: We studied 111 patients after MI occurred > 60 days (27 [9; 84] months) before enrollment (84 men; mean age 64.1±10.5 years). All subjects had 24-hour ambulatory ECG monitoring with HRT, DC and mTWA evaluation. Follow-up period was 60 months; primary endpoint was SCD, secondary endpoint included all non-sudden cardiovascular deaths.Results: During follow-up, we registered 19 cases of SCD and 11 cases of non-sudden cardiovascular deaths (including 7 fatal MI and 3 fatal strokes). DC had high negative predictive value (97.4% for all-cause mortality and 93.7% for SCD). DC values below 4.15 for all-cause mortality and 2.0 for SCD significantly increased risk of all-cause mortality (OR 8.5, 95% CI 2.9 to 24.6, р<0.001) и SCD (OR 9.6, 95% CI 3.2 to 28.5, р<0.001). Combined risk assessment at 12 months revealed that the most significant combination was HRT2 and mTWA100 > 53 mcV, which increased risk both of all-cause mortality (30.7-fold) and SCD (63.3-fold); however, at 60 months this predictive value for SCD decreased (OR = 20.8 (95% CI 2.8 to 114.0), p <0.001).Conclusion: Evaluation of HRT, DC and mTWA during 24-hour ECG monitoring may define the high risk of cardiovascular mortality and SCD in post-MI patients especially during the first 12 months after the baseline examination.

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JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia

Takase,

Ikeda,

Shimizu

et al. 2024

Journal of Arrhythmia

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This article is to be co-published with Circulation Journal. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.This document is an English version of JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia reported at the 86th Annual Scientific Meeting of Japanese Circulation Society performed in 2022.

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Simultaneous Assessment of T-Wave Alternans and Heart Rate Turbulence on Holter Electrocardiograms as Predictors for Serious Cardiac Events in Patients After Myocardial Infarction

Cited by 45 publications

References 23 publications

Gender-dependent profile of heart rate turbulence parameters in patients after acute myocardial infarction treated invasively

Gender-dependent profile of heart rate turbulence parameters in patients after acute myocardial infarction treated invasively

Long-term Non-Invasive ECG-based Risk Stratification of Sudden Cardiac Death: Extended 5-year Results

JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia

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