Key result
Continuous multi-day ECG tracking in post-MI patients showed that severely elevated T-wave alternans at discharge declined by 50% (from 80 to 40 μV, p=0.03) by day 40 in STEMI patients.
Why the study?
Sudden cardiac death risk is elevated after acute myocardial infarction, but the time course of post-MI susceptibility requires further investigation.
Does continuous multi-day ECG patch monitoring detect changes in cardiac electrical stability and autonomic tone in post-myocardial infarction patients?
Cohort (n=10)
Does continuous multi-day ECG patch monitoring detect changes in cardiac electrical stability and autonomic tone in post-myocardial infarction patients?
Continuous multi-day ECG patch monitoring can track the recovery of cardiac electrical stability and autonomic tone post-myocardial infarction, providing proof-of-principle for personalized sudden cardiac death risk assessment.
Early post-MI electrical instability may warrant intensified monitoring; extends time-course data but leaves open prospective intervention trials.
BACKGROUND: Sudden cardiac death (SCD) risk is elevated following acute myocardial infarction (MI). The time course of SCD susceptibility post-MI requires further investigation. METHODS: In this observational cohort study, we employed state-of-the-art noninvasive ECG techniques to track the daily time course of cardiac electrical instability and autonomic function following ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Preventice BodyGuardian MINI-EL Holters continuously recorded ECGs for 7 days at hospital discharge and at 40 days for STEMI (N = 5) or at 90 days for NSTEMI patients (N = 5). Cardiac electrical instability was assessed by T-wave alternans (TWA) and T-wave heterogeneity (TWH); autonomic tone was determined by rMSSD-heart rate variability (HRV). RESULTS: TWA was severely elevated (≥60 μV) in STEMI patients (80 ± 10.3 μV) at discharge and throughout the first recording period but declined by 50% to 40 ± 2.3 μV (p = .03) by Day 40 and remained in the normal range (<47 μV). TWH, a related phenomenon analyzed from 12-lead ECGs, was reduced by 63% in the five STEMI patients from discharge to normal (<80 μV) at follow-up (105 ± 27.3 to 39 ± 3.3 μV, p < .04) but increased by 65% in a STEMI case (89 to 147 μV), who received a wearable defibrillator vest and later implantable cardioverter defibrillator. In NSTEMI patients, TWA was borderline abnormal (47 ± 3.3 μV) at discharge and declined by 19% to normal (38 ± 1.2 μV) by Day 90 (p = .05). An overall reciprocal increase in rMSSD-HRV suggested recovery of vagal tone. CONCLUSIONS: This study provides proof-of-principle for tracking post-MI SCD risk in individual patients with implications for personalized therapy.
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Verrier et al. (2023) conducted a cohort in Acute myocardial infarction (STEMI and NSTEMI) (n=10). Continuous multi-day ECG patch monitoring vs. Hospital discharge (baseline) was evaluated on Cardiac electrical instability assessed by T-wave alternans (TWA) and T-wave heterogeneity (TWH) (p=0.03). Continuous multi-day ECG tracking in post-MI patients showed that severely elevated T-wave alternans at discharge declined by 50% (from 80 to 40 μV, p=0.03) by day 40 in STEMI patients.
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