Morphologic variability in beat space (MVB) was significantly associated with 1-year cardiovascular death in post-ACS patients with low-to-moderate TIMI risk scores (HR 3.0; P=0.01).
Cohort (n=1,082)
Does quantifying morphologic variability in beat space (MVB) on ECG improve risk stratification for cardiovascular death in patients after acute coronary syndrome?
The novel ECG metric morphologic variability in beat space (MVB) provides independent prognostic information for cardiovascular death in post-ACS patients, particularly those with low-to-moderate clinical risk scores.
Effect estimate: HR 3.0
p-value: p=0.01
Background Identification of patients who are at high risk of adverse cardiovascular events after an acute coronary syndrome ( ACS ) remains a major challenge in clinical cardiology. We hypothesized that quantifying variability in electrocardiogram ( ECG) morphology may improve risk stratification post‐ ACS . Methods and Results We developed a new metric to quantify beat‐to‐beat morphologic changes in the ECG : morphologic variability in beat space ( MVB ), and compared our metric to published ECG metrics (heart rate variability HRV , deceleration capacity DC , T‐wave alternans, heart rate turbulence, and severe autonomic failure). We tested the ability of these metrics to identify patients at high risk of cardiovascular death ( CVD ) using 1082 patients (1‐year CVD rate, 4.5%) from the MERLIN ‐ TIMI 36 (Metabolic Efficiency with Ranolazine for Less Ischemia in Non‐ ST ‐Elevation Acute Coronary Syndrome—Thrombolysis in Myocardial Infarction 36) clinical trial. DC , HRV/low frequency–high frequency, and MVB were all associated with CVD (hazard ratios HRs from 2.1 to 2.3 P <0.05 for all after adjusting for the TIMI risk score TRS , left ventricular ejection fraction LVEF , and B‐type natriuretic peptide BNP ). In a cohort with low‐to‐moderate TRS (N=864; 1‐year CVD rate, 2.7%), only MVB was significantly associated with CVD (HR, 3.0; P =0.01, after adjusting for LVEF and BNP ). Conclusions ECG morphological variability in beat space contains prognostic information complementary to the clinical variables, LVEF and BNP, in patients with low‐to‐moderate TRS . ECG metrics could help to risk stratify patients who might not otherwise be considered at high risk of CVD post‐ ACS .
Liu et al. (Thu,) conducted a cohort in Acute Coronary Syndrome (n=1,082). Morphologic variability in beat space (MVB) vs. Published ECG metrics (HRV, DC, T-wave alternans, heart rate turbulence, severe autonomic failure) was evaluated on Cardiovascular death (HR 3.0, p=0.01). Morphologic variability in beat space (MVB) was significantly associated with 1-year cardiovascular death in post-ACS patients with low-to-moderate TIMI risk scores (HR 3.0; P=0.01).