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. 2020 Jun 16;9(6):1879.
doi: 10.3390/jcm9061879.

Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure

Gianfranco Piccirillo  1 , Federica Moscucci  1 , Gaetano Bertani  1 , Ilaria Lospinuso  1 , Fabiola Mastropietri  1 , Marcella Fabietti  1 , Teresa Sabatino  1 , Giulia Zaccagnini  1 , Davide Crapanzano  1 , Ilaria Di Diego  1 , Andrea Corrao  1 , Pietro Rossi  2 , Damiano Magrì  3
Affiliations

Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure

Gianfranco Piccirillo et al. J Clin Med. .

Abstract

Background and objectives: Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values.

Method: One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN).

Results: Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTeSD (p < 0.01), QTpSD (p < 0.05), mean Te (p < 0.05), TeSD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only TeSD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTeSD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for TeSD (AUC: 0.736, p < 0.001) and QTeSD (AUC: 0.696, p < 0.01).

Conclusion: Both mean Te and TeSD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162).

Keywords: QT; QTVI, QT variability index; T peak–T end; chronic heart failure; mortality; temporal dispersion of repolarization phase..

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Conflict of interest statement

The Authors deny personal or financial conflicts of interest regarding this paper.

Figures

Figure 1
Figure 1
Linear regression between log TeSD and NT-proBNP. NT-proBNP: N-terminal Pro Brain Natriuretic Peptide; SD: standard deviation.
Figure 2
Figure 2
(A) QTe, QTp and Te means in the cardiovascular and non-cardiovascular deceased subjects. In the box plots, the central line represents the median distribution. Each box spans from the 25th to 75th percentile points, and error bars extend from the 10th to 90th percentile points. (B) QTe, QTp and Te standard deviations (SD) in the cardiovascular and non-cardiovascular deceased subjects. In the box plots, the central line represents the median distribution. Each box spans from the 25th to 75th percentile points, and error bars extend from the 10th to 90th percentile points.In the ROC analysis, the highest accuracy for 30-day mortality was found for the following variables: QTeSD (AUC: 0.705, p < 0.01), mean Te (AUC: 0.680, p < 0.01), QTeVN (AUC: 0.686, p < 0.01) and TeSD (AUC: 0.648, p < 0.05) (Figure 3A). ROC, receiver operating characteristic; AUC, area under curve; NS, not significant. QTe, QTp, Te, QTeVN (explained in the text).
Figure 3
Figure 3
(A,B) ROC curve of statistically significant examined variables. Sensitivity–specificity of different variables for mortality (A) and higher NT-proBNP levels (≥75th percentile) (B). Univariable Cox regression analysis reported a significant relationship between 30-day mortality and QTeSD (hazard ratio: 1.10, 95% confidence limit: 1.03–1.18, p < 0.05), mean Te (hazard ratio 1.02, 95% confidence limit: 1.01–1.04, p < 0.001) and TeSD (hazard ratio 1.12, 95% confidence limit: 1.01–1.23, p < 0.001) (Table 3). All number value in the table of the figure should be intended as follow: .526 means 0.526.
Figure 4
Figure 4
(A) Kaplan–Meier survival curve for total mortality by subdividing the study subjects with a cutoff at the 75th percentile of mean Te. (B) Kaplan–Meier survival curve for cardiovascular mortality by subdividing the study subjects with a cutoff at the 75th percentile of mean Te.
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