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Ischemic electrocardiographic abnormalities and prognosis in decompensated heart failure

Douglas Greig1, Peter C Austin1, Limei Zhou1

  • 1From the Division of Cardiology, Peter Munk Cardiac Centre (D.G., H.J.R., D.S.L.) and Joint Department of Medical Imaging (D.S.L.), University Health Network, Toronto, Canada; University of Toronto, Toronto, Canada (D.G., P.C.A., J.V.T., H.J.R., D.S.L.); Division of Cardiovascular Diseases, School of Medicine, P. Universidad Católica de Chile, Santiago, Chile (D.G.); Institute for Clinical Evaluative Sciences, Toronto, Canada (P.C.A., L.Z., J.V.T., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (P.C.A., J.V.T., D.S.L.); Division of Cardiology, Sunnybrook Schulich Heart Centre, Toronto, Canada (J.V.T.); and Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis (P.S.P.).

Circulation. Heart Failure
|October 5, 2014
PubMed

Insights

ST-depression on ECG identifies 30-day mortality risk in acute heart failure patients. This finding improves risk stratification, distinguishing high- and low-risk individuals for better management.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Clinical Risk Stratification

Background:

  • Coronary ischemia identification is crucial for acute heart failure management.
  • Assessing the risk of 30-day mortality linked to ischemic electrocardiogram (ECG) abnormalities in acute heart failure patients is vital.

Purpose of the Study:

  • To determine the association between ischemic ECG abnormalities and 30-day mortality in patients with acute heart failure.
  • To evaluate the impact of ST-depression on improving existing risk prediction models for acute heart failure mortality.

Main Methods:

  • Retrospective analysis of 8772 patients presenting with acute heart failure across 86 emergency departments in Ontario, Canada.
  • Evaluation of ECG findings (Q-waves, T-wave inversion, ST-depression) and their correlation with 30-day mortality.
  • Utilized continuous net reclassification improvement and logistic regression to assess the predictive value of ST-depression addition to the Emergency Heart Failure Mortality Risk Grade model.

Main Results:

  • ST-depression was the sole ischemic ECG abnormality significantly associated with 30-day mortality (adjusted OR 1.24).
  • Adding ST-depression to the Emergency Heart Failure Mortality Risk Grade model reclassified 16.9% of patients (29.3% with prior ischemic heart disease).
  • The enhanced model demonstrated high discrimination (c-statistic 0.801), with mortality rates increasing significantly across risk deciles.

Conclusions:

  • ST-depression on ECG is a significant independent predictor of 30-day mortality in acute heart failure.
  • The presence of ST-depression effectively reclassifies mortality risk, identifying both high- and low-risk patient subsets.
  • Incorporating ST-depression into risk models enhances the prediction of short-term mortality in acute heart failure.
Abstract

Keywords:
electrocardiographyheart failuremortalityprognosis

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