Key result
Reduced HRV is linked to ~359% higher inducible VT risk in post-MI patients with preserved EF.
Why the study?
Risk stratification for sudden cardiac death in post-MI patients remains challenging, prompting evaluation of noninvasive risk factors from 45-min short resting Holter ECG recordings to predict VT inducibility in patients with preserved LVEF.
Does heart rate variability from 45-min short resting Holter ECG predict ventricular tachycardia inducibility in post-MI patients with preserved LVEF?
Observational (n=99)
Yes
Does heart rate variability from 45-min short resting Holter ECG predict ventricular tachycardia inducibility in post-MI patients with preserved LVEF?
Heart rate variability assessed from a 45-minute short resting Holter ECG can help identify post-MI patients with preserved LVEF who are at higher risk for inducible ventricular tachycardia.
BACKGROUND: Risk stratification for sudden cardiac death in post-myocardial infarction (post-MI) patients remains a challenging task. Several electrocardiographic noninvasive risk factors (NIRFs) have been associated with adverse outcomes and were used to refine risk assessment. This study aimed to evaluate the performance of NIRFs extracted from 45-min short resting Holter ECG recordings (SHR), in predicting ventricular tachycardia inducibility with programmed ventricular stimulation (PVS) in post-MI patients with preserved left ventricular ejection fraction (LVEF). METHODS: We studied 99 post-MI ischemia-free patients (mean age: 60.5 ± 9.5 years, 86.9% men) with LVEF ≥40%, at least 40 days after revascularization. All the patients underwent PVS and a high-resolution SHR. The following parameters were evaluated: mean heart rate, ventricular arrhythmias (premature ventricular complexes, couplets, tachycardias), QTc duration, heart rate variability (HRV), deceleration capacity, heart rate turbulence, late potentials, and T-wave alternans. RESULTS: PVS was positive in 24 patients (24.2%). HRV, assessed by the standard deviation of normal-to-normal R-R intervals (SDNN), was significantly decreased in the positive PVS group (42 ms vs. 51 ms, p = .039). SDNN values <50 ms were also associated with PVS inducibility (OR 3.081, p = .032 in univariate analysis, and 4.588, p = .013 in multivariate analysis). No significant differences were identified for the other NIRFs. The presence of diabetes, history of ST-elevation MI (STEMI) and LVEF <50% were also important predictors of positive PVS. CONCLUSIONS: HRV assessed from SHR, combined with other noninvasive clinical and echocardiographic variables (diabetes, STEMI history, LVEF), can provide an initial, practical, and rapid screening tool for arrhythmic risk assessment in post-MI patients with preserved LVEF.
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Triantafyllou et al. (2023) conducted an observational in Post-myocardial infarction with preserved ejection fraction (n=99). Reduced heart rate variability (SDNN < 50 ms) on 45-min short resting Holter ECG vs. Normal heart rate variability (SDNN ≥ 50 ms) was evaluated on Ventricular tachycardia inducibility with programmed ventricular stimulation (PVS) (OR 4.588, 95% CI 1.378-15.275, p=0.013). Reduced heart rate variability (SDNN < 50 ms) on a 45-minute resting Holter ECG was independently associated with a significantly increased risk of inducible ventricular tachycardia (OR 4.588) in post-MI patients with preserved ejection fraction.
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