Dynamic Changes in High-Sensitivity Cardiac Troponin I Are Associated with Dynamic Changes in Sum Absolute QRST
Larisa G Tereshchenko1,2, Albert Feeny3, Erica Shelton4
1The Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Insights
Patient-specific changes in Sum Absolute QRST Integral (SAI QRST) and myocardial injury (hsTnI) are linked. This association suggests a common mechanism underlying both ECG changes and cardiac damage in patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Clinical Electrophysiology
Background:
- The Sum Absolute QRST Integral (SAI QRST), a 3D ECG metric, predicts ventricular arrhythmias in heart failure (HF) patients.
- Cardiac resynchronization therapy (CRT) responders with HF may benefit from SAI QRST monitoring.
- The relationship between dynamic SAI QRST changes and myocardial injury markers like hsTnI is not well understood.
Purpose of the Study:
- To investigate the association between patient-specific changes in SAI QRST and myocardial injury measured by hsTnI.
- To determine if dynamic changes in SAI QRST correlate with acute cardiac injury markers.
- To explore potential shared mechanisms between electrical heterogeneity and myocardial damage.
Main Methods:
- Prospective cohort study of 398 emergency department patients.
- Simultaneous measurement of SAI QRST and hsTnI every 3 hours over a 12-hour period.
- Random-effects linear regression analysis adjusted for demographics, cardiovascular disease, risk factors, and LBBB.
Main Results:
- SAI QRST decreased by 3 mV*ms every 3 hours in the overall cohort.
- A 10-fold increase in hsTnI correlated with a 7.7 mV*ms increase in SAI QRST.
- In acutely decompensated HF patients, a 10-fold hsTnI increase was linked to a 61.0 mV*ms increase in SAI QRST.
Conclusions:
- Patient-specific, time-varying changes in SAI QRST and hsTnI are independently and directly associated.
- This association suggests a common underlying mechanism linking global electrical heterogeneity and myocardial injury.
- SAI QRST may serve as a non-invasive marker reflecting ongoing myocardial injury.
Background:
A three-dimensional electrocardiographic (ECG) metric, the sum absolute QRST integral (SAI QRST), predicts ventricular arrhythmias in heart failure (HF) patients with implantable cardioverter defibrillator and mechanical response to cardiac resynchronization therapy. We hypothesized that there is an association between patient-specific changes in SAI QRST and myocardial injury as measured by high-sensitivity troponin I (hsTnI).
Methods:
Sum absolute integral QRST on resting 12-lead ECG and hsTnI were measured simultaneously, every 3 hours, and during 12-hour observation period in a prospective cohort of emergency department patients (n = 398; mean age 57.8 ± 13.2 years; 54% female, 64% black), diagnosed with acute coronary syndrome (ACS, n = 28), acutely decompensated HF (acute decompensated heart failure, n = 35), cardiac non-ACS (n = 19), or noncardiac condition (n = 316). Random-effects linear regression analysis assessed the association of SAI QRST and myocardial injury, with adjustment for demographics (age, sex, race), prevalent cardiovascular disease (myocardial infarction, history of revascularization, stroke, and HF), risk factors (diabetes, smoking, hypercholesterolemia, hypertension, and cocaine use), and left bundle branch block.
Results:
Within the entire cohort, SAI QRST decreased by 3 (95%CI -5 to -1) mV*ms every 3 hours. A 10-fold increase in hsTnI was associated with a 7.7 (0.6-14.9) mV*ms increase in SAI QRST. In the subgroup of acutely decompensated HF patients (n = 35), a 10-fold increase in hsTnI was associated with a 61.0 (5.9-116.1) mV*ms increase in SAI QRST.
Conclusion:
Patient-specific time-varying changes in the surface ECG scalar measure of global electrical heterogeneity, as measured by SAI QRST, and in myocardial injury as measured by hsTnI, are independently and directly associated with each other, likely reflecting a common underlying mechanism.
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