Prognostic significance of the Holter-derived T-wave variability in patients with ventricular tachyarrhythmias complicating acute coronary syndrome—TWIST study

Taro Makino, Tomohide Ichikawa, Mari Amino, Mari Nakamura, Masayuki Koshikawa, Yuji Motoike, Yoshihiro Nomura, Masahide Harada, Yoshihiro Sobue, Eiichi Watanabe, Ken Kiyono, Koichiro Yoshioka, Yuji Ikari, Yukio Ozaki, Hideo Izawa

研究成果: ジャーナルへの寄稿学術論文査読

抄録

Background: We aimed to investigate the association between ventricular repolarization instability and sustained ventricular tachycardia and ventricular fibrillation (VT/VF) occurring within 48 h (acute-phase VT/VF) after the onset of acute coronary syndrome (ACS) and the prognostic role of repolarization instability and heart rate variability (HRV) after discharge from the hospital. Methods: We studied 572 ACS patients with a left ventricular ejection fraction >35%. The ventricular repolarization instability was assessed by the beat-to-beat T-wave amplitude variability (TAV) using high-resolution 24-h Holter ECGs recorded at a median of 11 days from the date of admission. We calculated the HRV parameters including the deceleration capacity (DC) and non-Gaussian index calculated on a 25 s timescale (λ25s). The DC and λ25s were dichotomized based on previous studies' thresholds. Results: Acute-phase VT/VF developed in 43 (7.5%) patients. In-hospital mortality was significantly higher among VT/VF patients (4.7% vs. 0.9%, p =.03). An adjusted logistic model showed that the maximum TAV (odds ratio 1.02, 95% confidence interval [CI] 1.00–1.29, p =.04) was associated with acute-phase VT/VF. During a median follow-up period of 2.1 years, 19 (3.3%) patients had cardiac deaths or resuscitated cardiac arrest. Acute-phase VT/VF (p =.12) and TAV (p =.72) were not significant predictors of survival. An age and sex-adjusted Cox model showed that the DC (p <.01), λ25s (p <.01), and emergency coronary intervention (p <.01) were independent predictors. Conclusion: T-wave amplitude variability was associated with acute-phase VT/VF, but the TAV was not predictive of survival post-discharge. The DC, λ25s, and emergency coronary intervention were independent predictors of survival.

本文言語英語
論文番号e13069
ジャーナルAnnals of Noninvasive Electrocardiology
28
6
DOI
出版ステータス出版済み - 11-2023

All Science Journal Classification (ASJC) codes

  • 循環器および心血管医学
  • 生理学(医学)

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