Augmented Oscillations in QT Interval Duration Predict Mortality Post Myocardial Infarction Independent of Heart Rate.

El-Hamad, Fatima J; Bonabi, Safa Y; Müller, Alexander; Steger, Alexander; Schmidt, Georg; Baumert, Mathias

doi:10.3389/fphys.2020.578173

Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)

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Document type:: Article; Journal Article
Author(s):: El-Hamad, Fatima J; Bonabi, Safa Y; Müller, Alexander; Steger, Alexander; Schmidt, Georg; Baumert, Mathias
Title:: Augmented Oscillations in QT Interval Duration Predict Mortality Post Myocardial Infarction Independent of Heart Rate.
Abstract:: Objective: This study seeks to decompose QT variability (QTV) into physiological sources and assess their role for risk stratification in patients post myocardial infarction (MI). We hypothesize that the magnitude of QTV that cannot be explained by heart rate or respiration carries important prognostic information. Background: Elevated beat-to-beat QTV is predictive of cardiac mortality, but the underlying mechanisms, and hence its interpretation, remain opaque. Methods: We decomposed the QTV of 895 patients post MI into contributions by heart rate, respiration, and unexplained sources. Results: Cox proportional hazard analysis demonstrates that augmented oscillations in QTV and their level of dissociation from heart rate are associated with a higher 5-year mortality rate (18.4% vs. 4.7%, p < 0.0001). In patients with left ventricular ejection fraction (LVEF) > 35%, a higher QTV risk score was associated with a significantly higher 5-year mortality rate (16% vs. 4%, p < 0.0001). In patients with a GRACE score ≥ 120, a higher QTV risk score was associated with a significantly higher 5-year mortality (25% vs. 11%, p < 0.001). Conclusion: Augmented oscillations in QTV and discordance from heart rate, possibly indicative of excessive sympathetic outflow to the ventricular myocardium, predict high risk in patients post MI independent from established risk markers. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT00196274.
Journal title abbreviation:: Front Physiol
Year:: 2020
Journal volume:: 11
Fulltext / DOI:: doi:10.3389/fphys.2020.578173
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/33240101
Print-ISSN:: 1664-042X
TUM Institution:: I. Medizinische Klinik und Poliklinik (Kardiologie)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)2020