The highest QT variability index quartile was associated with increased cardiovascular death (subhazard ratio 1.67; 95% CI 1.14-2.47; P=0.009) and non-sudden cardiac death in heart failure patients.
Cohort (n=714)
Does elevated beat-to-beat QT variability index predict cardiovascular mortality and sudden cardiac death in patients with heart failure?
Increased QT variability index, driven by depressed heart rate variability, predicts cardiovascular mortality and non-sudden cardiac death, but not sudden cardiac death, in heart failure patients.
Hazard Ratio: 1.67 (95% CI 1.14–2.47)
p-value: p=0.009
BACKGROUND: The goal of the present study was to determine the predictive value of beat-to-beat QT variability in heart failure patients across the continuum of left ventricular dysfunction. METHODS AND RESULTS: Beat-to-beat QT variability index (QTVI), log-transformed heart rate variance, normalized QT variance, and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca heart failure study (mean age, 63.1±11.7; men, 70.6%; left ventricular ejection fraction >35% in 254 48%) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death (subhazard ratio, 1.67 95% CI, 1.14-2.47; P=0.009) and, in particular, with non-SCD (subhazard ratio, 2.91 1.69-5.01; P<0.001). Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular (subhazard ratio, 1.57 1.04-2.35; P=0.031) and non-SCD in multivariate competing risk model (subhazard ratio, 2.58 1.13-3.78; P=0.001). No interaction between QTVI and left ventricular ejection fraction was found. QTVI predicted neither noncardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability rather than increased QT variability was the reason for increased QTVI in the present study. CONCLUSIONS: Increased QTVI because of depressed heart rate variability predicts cardiovascular mortality and non-SCD but neither SCD nor extracardiac mortality in heart failure across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from heart failure patients at risk.
Tereshchenko et al. (Sun,) conducted a cohort in Heart failure (n=714). Elevated beat-to-beat QT variability index (QTVI) vs. Lower QTVI was evaluated on Cardiovascular death (subhazard ratio 1.67, 95% CI 1.14-2.47, p=0.009). The highest QT variability index quartile was associated with increased cardiovascular death (subhazard ratio 1.67; 95% CI 1.14-2.47; P=0.009) and non-sudden cardiac death in heart failure patients.