QT dynamicity: a prognostic factor for sudden cardiac death in chronic heart failure

Introduction: The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate predicts sudden death in patients with chronic heart failure (CHF). Methods: We prospectively included 175 CHF patients in sinus rhythm. QT dynamicity was evaluated by analyzi...

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Bibliographic Details
Published in:	European journal of heart failure Vol. 7; no. 2; pp. 269 - 275
Main Authors:	Pathak, Atul, Curnier, Daniel, Fourcade, Joëlle, Roncalli, Jéme, Stein, Phyllis K., Hermant, Patricia, Bousquet, Marc, Massabuau, Pierre, Sénard, Jean-Michel, Montastruc, Jean-Louis, Galinier, Michel
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 02-03-2005
Subjects:	Adult Aged Algorithms Death, Sudden, Cardiac - etiology Electrocardiography, Ambulatory Female Follow-Up Studies Heart Failure - complications Heart Failure - mortality Heart Failure - physiopathology Heart Rate - physiology Humans Male Middle Aged Prospective Studies Severity of Illness Index Stroke Volume - physiology Ventricular Function, Left - physiology
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Summary:	Introduction: The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate predicts sudden death in patients with chronic heart failure (CHF). Methods: We prospectively included 175 CHF patients in sinus rhythm. QT dynamicity was evaluated by analyzing 24‐h Holter recordings. The linear regression slope of QT interval measured to the apex and to the end of T wave plotted against RR intervals was calculated using a dedicated Holter algorithm. Results: Mean follow‐up was 29.9±17.9 months. There were 48 deaths, of which 21 were sudden. The actuarial 3‐year mortality rates were 38.4% for overall mortality and 14.1% for sudden death. Of all the parameters, an increased QTe/RR slope (>0.28) was the strongest independent predictor of sudden death (relative risk 3.47, 95% confidence interval 1.43−8.40, p=0.006). Conclusion: Increased 24‐h QTe dynamicity is independently predictive of sudden death among patients with heart failure. This simple parameter may help to stratify risk and select patients who may benefit from antiarrhythmic prophylaxis.
Bibliography:	istex:2C490C5B0F694A676B451C4B88143025CB292498 ark:/67375/WNG-MM8DX5WM-D ArticleID:EJHF2004-10-016 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1388-9842 1879-0844
DOI:	10.1016/j.ejheart.2004.10.016