Key result
Short-term ECG repolarization markers QTeSD and mean Te predict 30-day mortality in decompensated heart failure.
Why the study?
Although ECG markers of temporal dispersion of myocardial repolarization identify high mortality risk in chronic HF, their ability to predict 30-day mortality in decompensated HF and their relationship with NT-proBNP warranted investigation.
Do short-term myocardial temporal dispersion ECG markers predict 30-day mortality in patients with decompensated heart failure?
Cohort (n=113)
No
Do short-term myocardial temporal dispersion ECG markers predict 30-day mortality in patients with decompensated heart failure?
Effect estimate: AUC 0.705
p-value: p=<0.01
Short-period temporal dispersion repolarization markers (QTeSD and mean Te) obtained via a 5-minute mobile phone ECG recording can predict 30-day mortality in patients with decompensated heart failure.
May support short-term risk stratification via mobile ECG in decompensated HF; hypothesis-generating and requires prospective validation.
Background and Objectives: Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values. Method: One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN). Results: Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTeSD (p < 0.01), QTpSD (p < 0.05), mean Te (p < 0.05), TeSD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only TeSD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTeSD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for TeSD (AUC: 0.736, p < 0.001) and QTeSD (AUC: 0.696, p < 0.01). Conclusion: Both mean Te and TeSD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162).
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Piccirillo et al. (2020) conducted a cohort in Decompensated heart failure (n=113). Short-term myocardial temporal dispersion ECG variables was evaluated on 30-day mortality (AUC 0.705, p=<0.01). Short-term ECG repolarization markers, specifically QTeSD (AUC 0.705) and mean Te (AUC 0.680), significantly predicted 30-day mortality in patients with decompensated heart failure (P<0.01).
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