Key result
Maximum T-wave amplitude variability links to ~2% higher acute-phase VT/VF risk but not post-discharge survival.
Why the study?
The study investigated the association between ventricular repolarization instability and acute-phase VT/VF after ACS, and the post-discharge prognostic role of repolarization instability and HRV.
Do Holter-derived T-wave amplitude variability and heart rate variability parameters predict acute-phase VT/VF and long-term survival in patients with acute coronary syndrome?
Observational (n=572)
Do Holter-derived T-wave amplitude variability and heart rate variability parameters predict acute-phase VT/VF and long-term survival in patients with acute coronary syndrome?
In patients with acute coronary syndrome, Holter-derived T-wave amplitude variability is associated with acute-phase VT/VF, while heart rate variability parameters (DC and λ25s) independently predict long-term survival.
May flag acute VT/VF risk in ACS; hypothesis-generating and requires prospective validation before clinical use.
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.
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Makino et al. (2023) conducted an observational in Acute coronary syndrome (n=572). T-wave amplitude variability (TAV) was evaluated on Acute-phase VT/VF (OR 1.02, 95% CI 1.00-1.29, p=0.04). Maximum T-wave amplitude variability was associated with acute-phase VT/VF (OR 1.02; 95% CI 1.00-1.29; p=0.04) but did not predict survival post-discharge.
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