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Published on: May 28, 2019
Electrocardiographic parameters effectively predict ventricular tachycardia/fibrillation in acute phase and abnormal
Ziqing Yu1,2, Zhangwei Chen1, Yuan Wu1
1Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, PR China.
Insights
Electrocardiographic parameters like QTc and TpTe intervals, particularly in premature ventricular contractions (PVCs), can predict life-threatening ventricular tachycardia/ventricular fibrillation (VT/VF) in ST-segment elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Abnormal cardiac repolarization is linked to ventricular tachycardia/ventricular fibrillation (VT/VF).
- ST-segment elevation myocardial infarction (STEMI) can lead to lethal VT/VF, which is currently difficult to predict.
- Cardiac repolarization dispersion is worsened by myocardial ischemia and infarction.
Purpose of the Study:
- To assess electrocardiographic parameters of the sinus rhythmic complex for predicting VT/VF in acute STEMI.
- To evaluate QT interval and T-peak to T-end (TpTe) interval for independent prediction of VT/VF.
- To investigate if QT and TpTe of premature ventricular contractions (PVCs) can predict VT/VF in STEMI.
Main Methods:
- A total of 198 STEMI patients with PVCs on admission were analyzed.
- Logistic analysis was used to identify independent electrocardiographic predictors of VT/VF.
- Specific intervals including QTcPVC, TpTe, TpTePVC, TpTe/QT, and TpTe/QTPVC were measured and analyzed.
Main Results:
- QTcPVC > 520 ms, TpTe > 100 ms, TpTePVC > 101 ms, TpTe/QT > 0.258, and TpTe/QTPVC > 0.253 were significant predictors of VT/VF.
- QRS duration, QTc interval, coupling interval, and QRS PVC duration did not predict VT/VF.
- QRS PVC duration > 140 ms predicted a decrease in left ventricular ejection fraction (LVEF) long-term.
Conclusions:
- QTcPVC, TpTe, TpTePVC, TpTe/QT, and TpTe/QTPVC are independent risk factors for predicting VT/VF in acute STEMI.
- PVC characteristics predict both acute VT/VF and chronic LVEF decrease.
- These findings offer novel electrocardiographic markers for risk stratification in STEMI.
Background:
Abnormal cardiac repolarization is closely associated with ventricular tachycardia/ventricular fibrillation (VT/VF). Myocardial ischemia and infarction aggravate cardiac repolarization dispersion, and VT/VF could be lethal in the early stage of ST-segment elevation myocardial infarction (STEMI). Unfortunately, VT/VF cannot be effectively predicted in current clinical practice. The present study aimed to assess electrocardiographic parameters of the sinus rhythmic complex in relation to cardiac repolarization, e.g., QT interval and T-peak to T-end interval (TpTe), to independently predict VT/VF in acute STEMI. Additionally, we hypothesized that QT and TpTe of PVC would be also valuable to predict VT/VF in STEMI.
Methods And Results:
A total of 198 cases diagnosed as STEMI with PVC on admission by electrography were included. During hospitalization, VT/VF values were recorded. Logistic analysis was performed between patients with and without VT/VF to validate independent electrocardiographic predictors. QTcPVC interval > 520 ms (OR = 3.2; P = 0.027), TpTe interval > 100 ms (OR = 3.1; P = 0.04), TpTePVC > 101 ms (OR = 3.6; P = 0.029), TpTe/QT > 0.258 (OR = 5.7; P = 0.003), and TpTe/QTPVC > 0.253 (OR = 3; P = 0.048). However, QRS duration, QTc interval, coupling interval, and QRSPVC duration did not predict VT/VF. Besides, QRSPVC duration >140 ms (OR = 2.6; P = 0.001) independently predicted LVEF decrease after 1 year or more.
Conclusions:
QTcPVC interval, TpTe interval, TpTePVC interval, TpTe/QT ratio, and TpTe/QTPVC ratio are risk factors for ECG independent from other confounding factors in predicting VT/VF in the acute phase of STEMI. In addition, PVC characteristics as risk factors for VT/VF in acute phase and LVEF decrease in chronic phase were firstly reported.
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