Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure

Gianfranco Piccirillo; Federica Moscucci; Gaetano Bertani; Ilaria Lospinuso; Fabiola Mastropietri; Marcella Fabietti; Teresa Sabatino; Giulia Zaccagnini; Davide Crapanzano; Ilaria Di Diego; Andrea Corrao; Pietro Rossi; Damiano Magrì

doi:10.3390/jcm9061879

Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure

J Clin Med. 2020 Jun 16;9(6):1879. doi: 10.3390/jcm9061879.

Affiliations

¹ Anestesiologiche e Cardiovascolari, Dipartimento di Scienze Cliniche Internistiche, Policlinico Umberto I, La Sapienza University of Rome, 00185 Rome, Italy.
² Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita, Isola Tiberina, 00186 Rome, Italy.
³ Dipartimento di Medicina Clinica e Molecolare, S. Andrea Hospital, Sapienza University of Rome, 00185 Rome, Italy.

Abstract

Background and objectives: Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values.

Method: One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN).

Results: Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTe_SD (p < 0.01), QTp_SD (p < 0.05), mean Te (p < 0.05), Te_SD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only Te_SD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTe_SD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for Te_SD (AUC: 0.736, p < 0.001) and QTe_SD (AUC: 0.696, p < 0.01).

Conclusion: Both mean Te and Te_SD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162).

Keywords: QT; QTVI, QT variability index; T peak–T end; chronic heart failure; mortality; temporal dispersion of repolarization phase..

Associated data

ClinicalTrials.gov/NCT04127162