Key result
ECG action potential duration restitution dynamics identify sudden cardiac death with 0.96 AUC.
Why the study?
Sudden cardiac death risk markers are needed in Chagas cardiomyopathy to predict sudden cardiac death in the low-intermediate subgroups of the Rassi risk score.
Do action potential duration restitution (APDR) dynamics predict sudden cardiac death in patients with Chagas cardiomyopathy?
Cross-Sectional (n=221)
Do action potential duration restitution (APDR) dynamics predict sudden cardiac death in patients with Chagas cardiomyopathy?
Effect estimate: AUC 0.96 (95% CI 0.89-0.98)
Action potential duration restitution dynamics derived from Holter monitoring can accurately identify patients with Chagas cardiomyopathy at high risk for sudden cardiac death.
May aid SCD risk stratification via Holter in Chagas cardiomyopathy; leaves open prospective validation before clinical adoption.
BACKGROUND: Sudden cardiac death (SCD) risk markers are needed in Chagas cardiomyopathy (CC). Action potential duration restitution (APDR) dynamics is capable of extracting information on cardiac regional heterogeneity. This study intends to develop a patient-specific variables-based algorithm to predict SCD in the low-intermediate subgroups of the Rassi risk score. METHODS: Cross-sectional study of patients who underwent 24-h Holter for research purposes between January 1992 and February 2017. From 4-h ECG segment, RR series were generated and APDR dynamics metrics were calculated. Classification tree and sensitivity analysis were applied. As outcomes, SCD, SCD-free and non-cardiovascular death and 34 variables were included. RESULTS: Two hundred twenty-one (129 in the group SCD-free, 80 in the SCD group and 12 non-cardiovascular death group) were analyzed. In the groups with and without SCD (209 patients), the median age was 66 years, 52% were female, the cardiac involvement was mild to moderate in 72% with a Rassi point median of 8 (IQ: 3 to 11). The SCD group had more ventricular remodeling and more ventricular electrical instability. The occurrence of a %beats QTend/TendQ ratio > 1 (AUC, 0.96 (95% CI 0.89-0.98) present in more than 56.7% of the 4-h ECG segments was sufficient to identify patients of the SCD subgroup. Variables representing different stages of CC were also relevant in the model. CONCLUSION: It is possible to use APDR dynamics as an adjuvant in the SCD risk assessment in a subgroup of patients with a high risk of SCD and a very low risk of non-CV death with high power of discrimination.
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Pedrosa et al. (2023) conducted a cross-sectional in Chagas cardiomyopathy (n=221). Action potential duration restitution (APDR) dynamics was evaluated on Sudden cardiac death (SCD) (AUC 0.96, 95% CI 0.89-0.98). Action potential duration restitution dynamics, specifically a %beats QTend/TendQ ratio >1 in >56.7% of ECG segments, identified sudden cardiac death with an AUC of 0.96 (95% CI 0.89-0.98).
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