Predictive value of beat-to-beat QT variability index across the continuum of left ventricular dysfunction: competing risks of noncardiac or cardiovascular death and sudden or nonsudden cardiac death.
Predictive value of beat-to-beat QT variability index across the continuum of left ventricular dysfunction: competing risks of noncardiac or cardiovascular death and sudden or nonsudden cardiac death.
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DOI：
10.1161/circep.112.970541
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发表时间：
2012-08-01
期刊：
影响因子：
--
通讯作者：
Zareba W
中科院分区：
文献类型：
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作者：
Tereshchenko LG;Cygankiewicz I;McNitt S;Vazquez R;Bayes-Genis A;Han L;Sur S;Couderc JP;Berger RD;de Luna AB;Zareba W
这项研究的目的是确定心力衰竭(HF)患者在整个左心功能不全过程中QT间期变异性的预测价值。533名MUSIC心内直视(MUSIC)HF研究参与者(平均年龄63.1±11.7岁；男性70.6%；LVEF和GT；254%[48%])和181名健康参与者在静息状态下测量了心率变异性(QTVI)、心率变异性(LogHRV)、归一化QT变异性(QTVN)以及心率变异性和QT变异性之间的一致性。在平均3.7年的随访期间，116名患者死亡，其中52名死于心脏性猝死(SCD)。在多变量竞争风险分析中，QTVI四分位数最高与心血管死亡相关[危险比(HR)1.67(95%可信区间1.14-2.47)，P=0.009]，特别是与非心脏性猝死相关[HR2.91(1.69-5.01)，P<；0.001]。在多变量竞争风险模型中，QTVI升高将97.5%的健康个体与心血管疾病[HR1.57(1.04-2.35)，P=0.031]和非心脏性猝死[HR2.58(1.13-3.78)，P=0.001]的高危人群分开。QTVI与LVEF之间无交互作用。QTVI既不能预测非心源性死亡(P=0.546)，也不能预测心源性死亡(P=0.945)。心率变异性(HRV)降低而不是QT变异性增加是QTVI增加的原因。心率变异性降低导致的QTVI增加可预测心血管死亡率和非猝死性心源性死亡，但心衰患者的心源性猝死和心外死亡率在整个左心功能不全过程中都不能预测。QTVI异常增大可将97.5%的健康个体与高危心力衰竭患者区分开来。
The goal of this study was to determine the predictive value of beat-to-beat QT variability in heart failure (HF) patients across the continuum of left ventricular dysfunction. Beat-to-beat QT variability index (QTVI), heart rate variance (LogHRV), normalized QT variance (QTVN), and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca (MUSIC) HF study (mean age 63.1±11.7; males 70.6%; LVEF >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance (IDEAL) database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death [hazard ratio (HR) 1.67(95%CI 1.14-2.47), P=0.009] and in particular with non-sudden cardiac death [HR 2.91(1.69-5.01), P<0.001]. Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular [HR 1.57(1.04-2.35), P=0.031], and non-sudden cardiac death in multivariate competing risk model [HR 2.58(1.13-3.78), P=0.001]. No interaction between QTVI and LVEF was found. QTVI predicted neither non-cardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability (HRV) rather than increased QT variability was the reason for increased QTVI in this study. Increased QTVI due to depressed HRV predicts cardiovascular mortality and non-sudden cardiac death, but neither SCD nor excracardiac mortality in HF across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from HF patients at risk.