Inflammatory Biomarkers and ECG Repolarization Metrics: Sudden Death in Heart Failure With Reduced Ejection Fraction

Area of Science:

• Cardiology
• Biomarkers
• Sudden Cardiac Death

Background:

• Sudden cardiac death (SCD) is a major cause of mortality in heart failure with reduced ejection fraction (HFrEF).
• The link between inflammatory biomarkers, ECG repolarization, and SCD in HFrEF is not fully understood.

Purpose of the Study:

• To investigate the association between ECG repolarization metrics, inflammatory biomarkers, and SCD in patients with HFrEF.
• To determine if inflammatory markers provide prognostic information for SCD beyond traditional ECG parameters.

Main Methods:

• Analysis of 4,391 HFrEF patients from the VICTORIA trial with baseline ECGs and biomarkers.
• Assessment of interleukin-6, growth differentiation factor-15, and hsCRP in relation to SCD.
• Utilized Cox proportional hazards and linear regression models, including JTc interval (QTc minus QRS duration).

Main Results:

• The JTc interval, but not QTc, was associated with SCD risk.
• High-sensitivity C-reactive protein (hsCRP) was independently associated with increased SCD risk in multivariable models.
• hsCRP provided the greatest prognostic value when added to the JTc interval model, indicating significant new information.

Conclusions:

• Inflammatory biomarkers, especially hsCRP, are independently linked to SCD in HFrEF patients.
• Inflammation appears to contribute to SCD risk via mechanisms separate from repolarization prolongation.
• hsCRP may enhance risk stratification for SCD in HFrEF.