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Prognostic value of myocardial electric instability markersin patients with ischemic heart disease

Authors: O.I. Gromova, E.V. Kuznetsova, Ch.V. Hotsanyan, E.Z. Golukhova

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

Type:  Stable ischemic heart disease


DOI: https://doi.org/10.15275/kreatkard.2015.03.03

For citation: Gromova O.I., Kuznetsova E.V., Hotsanyan Ch.V. et al. Prognostic value of myocardial electric instability markers in patients with ischemic heart disease. Creative Cardiology. 2015; 3: 26-41 (in Russian)

Keywords: sudden cardiac death malignant arrhythmias micrivolt T-wave alternans signal-averaged ECG late ventricular potentials filtered QRS duration heart rate turbulence

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Abstract

Objective. To estimate prognostic value of noninvasive electrophysiological tests as predictors of malignant ventricular arrhythmias (MA) in patients with CAD in long-term follow-up.

Material and methods. We prospectively enrolled 97 patients with CAD at the mean age of 61±10 years. The mean left ventricular ejection fraction (LVEF) was 50±13%. We defined 2 groups of pts: preserved LVEF (>40%) (n=66), and reduced LVEF (≤40%) (n=31). We calculated following noninvasive electrophysiological markers as part of 24-hour Holter monitoring: microvolt T-wave alternans (MTWA), signal-averaged electrocardiography (SAECG), Q–T-interval duration and dynamics, heart rate turbulence (HRT) and variability (HRV). Most of pts (89%) were revascularized before enrolling for during follow-up.

Results. Life-threatening ventricular arrhythmias were observed in 11 (11%) patients during mean follow-up period of 25±11 months: 5 (8%) in pts with preserved LVEF, and 6 (18%) in pts with LVEF≤40%. Cardiac mortality was 8% in common group: 3 and 19% in each group of pts. According to univariate analysis predictors of MA were: filtered QRS (P<0,05); abnormal HRT (P=0,01) and turbulence slope (TS) (P<0,01). The last two parameters were also significantly associated with cardiac mortality (P=0,002 и P<0,0001, respectively). Abnormal TRS was independent predictor of MA according to multivariate Cox regression analysis (P<0,01). Late ventricular potentials (LVP) by SAECG were associated with MA in pts with preserved LVEF (P=0,043). Neither of analyzed ECG parameters had significant association with MA in pts with LVEF≤40%. Non-negative MTWA-test and turbulence onset (TО) predicted cardiac mortality in pts with reduced EF (P=0,018 and P=0,02, respectively).

Conclusion. Abnormal HRT is independent predictor of MA in CAD pts and had significant influence on cardiac mortality. Late ventricular potentials can be predictors of MA in pts with LVEF>40%. Non-negative MTWA-test and abnormal TO are associated with cardiac mortality in pts with LVEF≤40%.

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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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