Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings: the JANIES-SHD study

Toshio Kinoshita, Kenichi Hashimoto, Koichiro Yoshioka, Yosuke Miwa, Kenji Yodogawa, Eiichi Watanabe, Kohki Nakamura, Mikiko Nakagawa, Kentaro Nakamura, Tetsu Watanabe, Satoru Yusu, Motomi Tachibana, Shiro Nakahara, Koichi Mizumaki, Takanori Ikeda

Research output: Contribution to journalArticle

Abstract

Background: Recent guidelines have stated that left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. However, little information is present regarding electrocardiographic (ECG) markers. This study aimed to assess ECG markers for predicting mortality or serious arrhythmia in patients with structural heart disease (SHD). Methods: In total, 1829 patients were enrolled into the Japanese Multicenter Observational Prospective Study (JANIES study). In this study, we analyzed data of 719 patients (569 men, age 64 ± 13 years) with SHD including mainly ischemic heart disease (65.8%). As ECG markers based on 24-hour Holter recordings, nonsustained ventricular tachycardia (NSVT), ventricular late potentials, and heart rate turbulence (HRT) were assessed. The primary endpoint was all-cause mortality, and the secondary endpoint was fatal arrhythmic events. Results: During a mean follow-up of 21 ± 11 months, all-cause mortality was eventually observed in 39 patients (5.4%). Among those patients, 32 patients (82%) suffered from cardiac causes such as heart failure and arrhythmia. Multivariate Cox regression analysis showed that after adjustment for age and LVEF, documented NSVT [hazard ratio = 2.46, 95% confidence interval (CI): 1.16–5.18, p = 0.02] and abnormal HRT (hazard ratio = 2.40, 95% CI: 1.16–4.93, p = 0.02) were significantly associated with the primary endpoint. These two ECG markers also had significant predictive values with the secondary endpoint. The combined assessment of two ECG markers improved predictive accuracy. Conclusion: This study demonstrated that combined assessment of documented NSVT and abnormal HRT based on 24-hour Holter ECG recordings are recommended for predicting future serious events in this population.

Original languageEnglish
JournalJournal of cardiology
DOIs
Publication statusAccepted/In press - 01-01-2019

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Heart Diseases
Mortality
Ventricular Tachycardia
Heart Rate
Stroke Volume
Cardiac Arrhythmias
Confidence Intervals
Observational Studies
Myocardial Ischemia
Heart Failure
Regression Analysis
Prospective Studies
Guidelines
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kinoshita, Toshio ; Hashimoto, Kenichi ; Yoshioka, Koichiro ; Miwa, Yosuke ; Yodogawa, Kenji ; Watanabe, Eiichi ; Nakamura, Kohki ; Nakagawa, Mikiko ; Nakamura, Kentaro ; Watanabe, Tetsu ; Yusu, Satoru ; Tachibana, Motomi ; Nakahara, Shiro ; Mizumaki, Koichi ; Ikeda, Takanori. / Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings : the JANIES-SHD study. In: Journal of cardiology. 2019.
@article{deb35380336f4c679632dbfc88eef957,
title = "Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings: the JANIES-SHD study",
abstract = "Background: Recent guidelines have stated that left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. However, little information is present regarding electrocardiographic (ECG) markers. This study aimed to assess ECG markers for predicting mortality or serious arrhythmia in patients with structural heart disease (SHD). Methods: In total, 1829 patients were enrolled into the Japanese Multicenter Observational Prospective Study (JANIES study). In this study, we analyzed data of 719 patients (569 men, age 64 ± 13 years) with SHD including mainly ischemic heart disease (65.8{\%}). As ECG markers based on 24-hour Holter recordings, nonsustained ventricular tachycardia (NSVT), ventricular late potentials, and heart rate turbulence (HRT) were assessed. The primary endpoint was all-cause mortality, and the secondary endpoint was fatal arrhythmic events. Results: During a mean follow-up of 21 ± 11 months, all-cause mortality was eventually observed in 39 patients (5.4{\%}). Among those patients, 32 patients (82{\%}) suffered from cardiac causes such as heart failure and arrhythmia. Multivariate Cox regression analysis showed that after adjustment for age and LVEF, documented NSVT [hazard ratio = 2.46, 95{\%} confidence interval (CI): 1.16–5.18, p = 0.02] and abnormal HRT (hazard ratio = 2.40, 95{\%} CI: 1.16–4.93, p = 0.02) were significantly associated with the primary endpoint. These two ECG markers also had significant predictive values with the secondary endpoint. The combined assessment of two ECG markers improved predictive accuracy. Conclusion: This study demonstrated that combined assessment of documented NSVT and abnormal HRT based on 24-hour Holter ECG recordings are recommended for predicting future serious events in this population.",
author = "Toshio Kinoshita and Kenichi Hashimoto and Koichiro Yoshioka and Yosuke Miwa and Kenji Yodogawa and Eiichi Watanabe and Kohki Nakamura and Mikiko Nakagawa and Kentaro Nakamura and Tetsu Watanabe and Satoru Yusu and Motomi Tachibana and Shiro Nakahara and Koichi Mizumaki and Takanori Ikeda",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jjcc.2019.07.012",
language = "English",
journal = "Journal of Cardiology",
issn = "0914-5087",
publisher = "Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)",

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Kinoshita, T, Hashimoto, K, Yoshioka, K, Miwa, Y, Yodogawa, K, Watanabe, E, Nakamura, K, Nakagawa, M, Nakamura, K, Watanabe, T, Yusu, S, Tachibana, M, Nakahara, S, Mizumaki, K & Ikeda, T 2019, 'Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings: the JANIES-SHD study', Journal of cardiology. https://doi.org/10.1016/j.jjcc.2019.07.012

Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings : the JANIES-SHD study. / Kinoshita, Toshio; Hashimoto, Kenichi; Yoshioka, Koichiro; Miwa, Yosuke; Yodogawa, Kenji; Watanabe, Eiichi; Nakamura, Kohki; Nakagawa, Mikiko; Nakamura, Kentaro; Watanabe, Tetsu; Yusu, Satoru; Tachibana, Motomi; Nakahara, Shiro; Mizumaki, Koichi; Ikeda, Takanori.

In: Journal of cardiology, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk stratification for cardiac mortality using electrocardiographic markers based on 24-hour Holter recordings

T2 - the JANIES-SHD study

AU - Kinoshita, Toshio

AU - Hashimoto, Kenichi

AU - Yoshioka, Koichiro

AU - Miwa, Yosuke

AU - Yodogawa, Kenji

AU - Watanabe, Eiichi

AU - Nakamura, Kohki

AU - Nakagawa, Mikiko

AU - Nakamura, Kentaro

AU - Watanabe, Tetsu

AU - Yusu, Satoru

AU - Tachibana, Motomi

AU - Nakahara, Shiro

AU - Mizumaki, Koichi

AU - Ikeda, Takanori

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Recent guidelines have stated that left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. However, little information is present regarding electrocardiographic (ECG) markers. This study aimed to assess ECG markers for predicting mortality or serious arrhythmia in patients with structural heart disease (SHD). Methods: In total, 1829 patients were enrolled into the Japanese Multicenter Observational Prospective Study (JANIES study). In this study, we analyzed data of 719 patients (569 men, age 64 ± 13 years) with SHD including mainly ischemic heart disease (65.8%). As ECG markers based on 24-hour Holter recordings, nonsustained ventricular tachycardia (NSVT), ventricular late potentials, and heart rate turbulence (HRT) were assessed. The primary endpoint was all-cause mortality, and the secondary endpoint was fatal arrhythmic events. Results: During a mean follow-up of 21 ± 11 months, all-cause mortality was eventually observed in 39 patients (5.4%). Among those patients, 32 patients (82%) suffered from cardiac causes such as heart failure and arrhythmia. Multivariate Cox regression analysis showed that after adjustment for age and LVEF, documented NSVT [hazard ratio = 2.46, 95% confidence interval (CI): 1.16–5.18, p = 0.02] and abnormal HRT (hazard ratio = 2.40, 95% CI: 1.16–4.93, p = 0.02) were significantly associated with the primary endpoint. These two ECG markers also had significant predictive values with the secondary endpoint. The combined assessment of two ECG markers improved predictive accuracy. Conclusion: This study demonstrated that combined assessment of documented NSVT and abnormal HRT based on 24-hour Holter ECG recordings are recommended for predicting future serious events in this population.

AB - Background: Recent guidelines have stated that left ventricular ejection fraction (LVEF) is the gold standard marker for identifying patients at risk for cardiac mortality. However, little information is present regarding electrocardiographic (ECG) markers. This study aimed to assess ECG markers for predicting mortality or serious arrhythmia in patients with structural heart disease (SHD). Methods: In total, 1829 patients were enrolled into the Japanese Multicenter Observational Prospective Study (JANIES study). In this study, we analyzed data of 719 patients (569 men, age 64 ± 13 years) with SHD including mainly ischemic heart disease (65.8%). As ECG markers based on 24-hour Holter recordings, nonsustained ventricular tachycardia (NSVT), ventricular late potentials, and heart rate turbulence (HRT) were assessed. The primary endpoint was all-cause mortality, and the secondary endpoint was fatal arrhythmic events. Results: During a mean follow-up of 21 ± 11 months, all-cause mortality was eventually observed in 39 patients (5.4%). Among those patients, 32 patients (82%) suffered from cardiac causes such as heart failure and arrhythmia. Multivariate Cox regression analysis showed that after adjustment for age and LVEF, documented NSVT [hazard ratio = 2.46, 95% confidence interval (CI): 1.16–5.18, p = 0.02] and abnormal HRT (hazard ratio = 2.40, 95% CI: 1.16–4.93, p = 0.02) were significantly associated with the primary endpoint. These two ECG markers also had significant predictive values with the secondary endpoint. The combined assessment of two ECG markers improved predictive accuracy. Conclusion: This study demonstrated that combined assessment of documented NSVT and abnormal HRT based on 24-hour Holter ECG recordings are recommended for predicting future serious events in this population.

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U2 - 10.1016/j.jjcc.2019.07.012

DO - 10.1016/j.jjcc.2019.07.012

M3 - Article

AN - SCOPUS:85071466914

JO - Journal of Cardiology

JF - Journal of Cardiology

SN - 0914-5087

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