Enhancing Comprehensive Assessments in Chronic Heart Failure Caused by Ischemic Heart Disease: The Diagnostic Utility
Ștefania-Teodora Duca1,2, Ionuț Tudorancea2,3, Mihai Ștefan Cristian Haba1,2
1Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania.
Insights
This study shows that 24-hour Holter ECG parameters like T-wave alternans (TWA) and late ventricular potentials (LVPs) can help diagnose chronic heart failure (CHF) caused by ischemic heart disease (IHD). Heart rate variability (HRV) also provides valuable insights into patient electrical vulnerability.
Area of Science:
- Cardiology
- Medical Diagnostics
- Biomedical Engineering
Background:
- Chronic heart failure (CHF) due to ischemic heart disease (IHD) is a leading global cause of mortality.
- Effective management of IHD necessitates advancements in prevention, early detection, and treatment strategies.
- Current diagnostic tools require enhancement to improve patient outcomes in IHD-related CHF.
Purpose of the Study:
- To evaluate the diagnostic utility of 24-hour Holter ECG parameters in patients with CHF caused by IHD.
- To assess T-wave alternans (TWA), late ventricular potentials (LVPs), and heart rate variability (HRV) for improved CHF diagnosis.
- To explore associations between these ECG parameters and comorbid conditions impacting CHF prognosis.
Main Methods:
- A prospective case-control study involving 150 participants (100 CHF patients, 50 controls).
- Data collection included medical history, physical examination, laboratory tests, echocardiography, and 24-hour Holter monitoring.
- Analysis focused on comparing TWA, LVPs, and various HRV metrics between CHF patients and controls.
Main Results:
- TWA and LVPs were significantly elevated in CHF patients, indicating increased myocardial electrical vulnerability (p < 0.01).
- Time and frequency-domain HRV parameters were significantly reduced in the CHF group.
- Specific HRV indices like SDNN Index showed significant differences based on left ventricular ejection fraction (LVEF) categories.
Conclusions:
- 24-hour Holter ECG parameters, including TWA, LVPs, and HRV, offer a reliable diagnostic approach for CHF.
- Integrating multiple Holter ECG parameters enhances the diagnostic assessment of IHD-related CHF.
- This comprehensive analysis provides a deeper understanding of patient condition and prognosis in CHF.
Abstract:
Background and Objectives: Chronic heart failure (CHF) caused by ischemic heart disease (IHD) is the leading cause of death worldwide and presents significant health challenges. Effective management of IHD requires prevention, early detection, and treatment to improve patient outcomes. This study aims to expand the diagnostic utility of various 24 h Holter ECG parameters, such as T-wave alternans (TWA), late ventricular potentials (LVPs), and heart rate variability (HRV) in patients with CHF caused by IHD. Additionally, we seek to explore the association between these parameters and other comorbid conditions affecting the prognosis of CHF patients. Materials and Methods: We conducted a prospective case-control study with 150 patients divided into two subgroups: 100 patients with CHF caused by IHD, and 50 patients in the control group. Data included medical history, physical examination, laboratory tests, echocardiography, and 24 h Holter monitoring. Results: Our comparative analysis demonstrated that both TWA and LVPs were significantly higher in patients with CHF compared to the control group (p < 0.01), indicating increased myocardial electrical vulnerability in CHF patients. Both time and frequency-domain HRV parameters were significantly lower in the CHF group. However, the ratio of NN50 to the total count of NN intervals (PNN50) showed a borderline significance (p = 0.06). While the low-frequency (LF) domain was significantly lower in CHF patients, the high-frequency (HF) domain did not differ significantly between groups. Acceleration and deceleration capacities were also significantly altered in CHF patients. Categorizing CHF patients by left ventricular ejection fraction (LVEF) revealed that the mean of the 5-min normal-to-normal intervals over the complete recording (SDNN Index) was significantly higher in patients with LVEF ≥ 50% compared to those with CHF with reduced EF and CHF with mildly reduced EF (p < 0.001), whereas the other HRV parameters showed no significant differences among the groups. Conclusions: Holter ECG parameters can become a reliable tool in the assessment of patients with CHF. The integration of multiple Holter ECG parameters, such as TWA, LVPs, and HRV, can significantly enhance the diagnostic assessment of CHF caused by IHD. This comprehensive approach allows for a more nuanced understanding of the patient's condition and potential outcomes.
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