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Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients
Background Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of...
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| Published in: | Journal of cardiovascular electrophysiology 2018-09, Vol.29 (9), p.1257-1264 |
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| container_end_page | 1264 |
| container_issue | 9 |
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| container_title | Journal of cardiovascular electrophysiology |
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| creator | Yamada, Shinya Yoshihisa, Akiomi Sato, Yu Sato, Takamasa Kamioka, Masashi Kaneshiro, Takashi Oikawa, Masayoshi Kobayashi, Atsushi Suzuki, Hitoshi Ishida, Takafumi Takeishi, Yasuchika |
| description | Background
Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of HF patients.
Methods
Our study comprised 215 patients (144 males, mean age 62 years) who had been hospitalized due to acute decompensated HF. Electrocardiogram (QRS duration and QTc interval) and 24‐hour Holter monitoring (heart rate variability, heart rate turbulence, and T‐wave alternans [TWA]) were performed in stable condition before discharge. The clinical characteristics and outcomes were then investigated.
Results
During a median follow‐up period of 2.7 years, there were 83 (38.6%) cardiac events (rehospitalization due to worsening HF [n = 51] or cardiac death [n = 32]). The patients with cardiac events had a lower turbulence slope (TS) and higher TWA compared to those without cardiac events (TS, 3.0 ± 5.5 ms/RR vs. 5.3 ± 5.6 ms/RR, P = 0.001; TWA, 66.1 ± 19.6 μV vs. 54.7 ± 15.1 μV, P |
| doi_str_mv | 10.1111/jce.13639 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2041631176</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2115795343</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3539-25c251cb2fd9494e142f54f40c6cab39a7d08ea18332dd038375d5c40c051b293</originalsourceid><addsrcrecordid>eNp10U9vFCEYBnBiNLZWD34BQ-JFD9PCAMNwNJv6L028tOfJO_BOlpUdVmDarCe_gX5GP4nYXT2YOBeG8OOB8BDynLNzXr-LjcVzLjphHpBTriRret7ph_WfSdWIXosT8iTnDWMVMfWYnLRGa62UOSXfb4oPvuxpnOgaIRWaoCAtSxqXgLNFCrOj1z-__biD2zoJBdMMc6YlUsgZc6bJ5890iokmBLf1Ofs43--ykJwHSx1CWVM_03XMO18g-K_ojqdN4MOSkO6geJxLfkoeTRAyPjuOZ-Tm7eX16n1z9endh9Wbq8YKJUzTKtsqbsd2ckYaiVy2k5KTZLazMAoD2rEegfdCtM4x0QutnLJ1nSk-tkackVeH3F2KXxbMZag3txgCzBiXPLRM8k5wrrtKX_5DN3GpjxCq4lxpo4QUVb0-KJtizgmnYZf8FtJ-4Gz43dJQWxruW6r2xTFxGbfo_so_tVRwcQB3PuD-_0nDx9XlIfIXN8ud4A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2115795343</pqid></control><display><type>article</type><title>Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Yamada, Shinya ; Yoshihisa, Akiomi ; Sato, Yu ; Sato, Takamasa ; Kamioka, Masashi ; Kaneshiro, Takashi ; Oikawa, Masayoshi ; Kobayashi, Atsushi ; Suzuki, Hitoshi ; Ishida, Takafumi ; Takeishi, Yasuchika</creator><creatorcontrib>Yamada, Shinya ; Yoshihisa, Akiomi ; Sato, Yu ; Sato, Takamasa ; Kamioka, Masashi ; Kaneshiro, Takashi ; Oikawa, Masayoshi ; Kobayashi, Atsushi ; Suzuki, Hitoshi ; Ishida, Takafumi ; Takeishi, Yasuchika</creatorcontrib><description>Background
Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of HF patients.
Methods
Our study comprised 215 patients (144 males, mean age 62 years) who had been hospitalized due to acute decompensated HF. Electrocardiogram (QRS duration and QTc interval) and 24‐hour Holter monitoring (heart rate variability, heart rate turbulence, and T‐wave alternans [TWA]) were performed in stable condition before discharge. The clinical characteristics and outcomes were then investigated.
Results
During a median follow‐up period of 2.7 years, there were 83 (38.6%) cardiac events (rehospitalization due to worsening HF [n = 51] or cardiac death [n = 32]). The patients with cardiac events had a lower turbulence slope (TS) and higher TWA compared to those without cardiac events (TS, 3.0 ± 5.5 ms/RR vs. 5.3 ± 5.6 ms/RR, P = 0.001; TWA, 66.1 ± 19.6 μV vs. 54.7 ± 15.1 μV, P < 0.001). Univariable analysis showed that TS, TWA, QRS duration, and QTc interval were associated with cardiac events (P = 0.004, P < 0.001, P = 0.037, and P = 0.024, respectively), while the multivariable analysis after the adjustment of multiple confounders showed that TS and TWA were independent predictive factors of cardiac events with a hazard ratio of 0.936 and 1.015 (95% confidence interval [CI]: 0.860–0.974, P = 0.006; and 95% CI: 1.003–1.027, P = 0.016), respectively.
Conclusion
The measurement of TS and TWA is useful for assessing risk for rehospitalization and cardiac death in HF patients.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.13639</identifier><identifier>PMID: 29777559</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>cardiac death ; Death ; EKG ; Electrocardiography ; Health risk assessment ; Heart diseases ; Heart failure ; Heart rate ; Heart rate turbulence ; Holter monitoring ; Males ; T‐wave alternans</subject><ispartof>Journal of cardiovascular electrophysiology, 2018-09, Vol.29 (9), p.1257-1264</ispartof><rights>2018 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-25c251cb2fd9494e142f54f40c6cab39a7d08ea18332dd038375d5c40c051b293</citedby><cites>FETCH-LOGICAL-c3539-25c251cb2fd9494e142f54f40c6cab39a7d08ea18332dd038375d5c40c051b293</cites><orcidid>0000-0001-6588-0764 ; 0000-0001-5726-3926</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29777559$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yamada, Shinya</creatorcontrib><creatorcontrib>Yoshihisa, Akiomi</creatorcontrib><creatorcontrib>Sato, Yu</creatorcontrib><creatorcontrib>Sato, Takamasa</creatorcontrib><creatorcontrib>Kamioka, Masashi</creatorcontrib><creatorcontrib>Kaneshiro, Takashi</creatorcontrib><creatorcontrib>Oikawa, Masayoshi</creatorcontrib><creatorcontrib>Kobayashi, Atsushi</creatorcontrib><creatorcontrib>Suzuki, Hitoshi</creatorcontrib><creatorcontrib>Ishida, Takafumi</creatorcontrib><creatorcontrib>Takeishi, Yasuchika</creatorcontrib><title>Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Background
Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of HF patients.
Methods
Our study comprised 215 patients (144 males, mean age 62 years) who had been hospitalized due to acute decompensated HF. Electrocardiogram (QRS duration and QTc interval) and 24‐hour Holter monitoring (heart rate variability, heart rate turbulence, and T‐wave alternans [TWA]) were performed in stable condition before discharge. The clinical characteristics and outcomes were then investigated.
Results
During a median follow‐up period of 2.7 years, there were 83 (38.6%) cardiac events (rehospitalization due to worsening HF [n = 51] or cardiac death [n = 32]). The patients with cardiac events had a lower turbulence slope (TS) and higher TWA compared to those without cardiac events (TS, 3.0 ± 5.5 ms/RR vs. 5.3 ± 5.6 ms/RR, P = 0.001; TWA, 66.1 ± 19.6 μV vs. 54.7 ± 15.1 μV, P < 0.001). Univariable analysis showed that TS, TWA, QRS duration, and QTc interval were associated with cardiac events (P = 0.004, P < 0.001, P = 0.037, and P = 0.024, respectively), while the multivariable analysis after the adjustment of multiple confounders showed that TS and TWA were independent predictive factors of cardiac events with a hazard ratio of 0.936 and 1.015 (95% confidence interval [CI]: 0.860–0.974, P = 0.006; and 95% CI: 1.003–1.027, P = 0.016), respectively.
Conclusion
The measurement of TS and TWA is useful for assessing risk for rehospitalization and cardiac death in HF patients.</description><subject>cardiac death</subject><subject>Death</subject><subject>EKG</subject><subject>Electrocardiography</subject><subject>Health risk assessment</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart rate</subject><subject>Heart rate turbulence</subject><subject>Holter monitoring</subject><subject>Males</subject><subject>T‐wave alternans</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp10U9vFCEYBnBiNLZWD34BQ-JFD9PCAMNwNJv6L028tOfJO_BOlpUdVmDarCe_gX5GP4nYXT2YOBeG8OOB8BDynLNzXr-LjcVzLjphHpBTriRret7ph_WfSdWIXosT8iTnDWMVMfWYnLRGa62UOSXfb4oPvuxpnOgaIRWaoCAtSxqXgLNFCrOj1z-__biD2zoJBdMMc6YlUsgZc6bJ5890iokmBLf1Ofs43--ykJwHSx1CWVM_03XMO18g-K_ojqdN4MOSkO6geJxLfkoeTRAyPjuOZ-Tm7eX16n1z9endh9Wbq8YKJUzTKtsqbsd2ckYaiVy2k5KTZLazMAoD2rEegfdCtM4x0QutnLJ1nSk-tkackVeH3F2KXxbMZag3txgCzBiXPLRM8k5wrrtKX_5DN3GpjxCq4lxpo4QUVb0-KJtizgmnYZf8FtJ-4Gz43dJQWxruW6r2xTFxGbfo_so_tVRwcQB3PuD-_0nDx9XlIfIXN8ud4A</recordid><startdate>201809</startdate><enddate>201809</enddate><creator>Yamada, Shinya</creator><creator>Yoshihisa, Akiomi</creator><creator>Sato, Yu</creator><creator>Sato, Takamasa</creator><creator>Kamioka, Masashi</creator><creator>Kaneshiro, Takashi</creator><creator>Oikawa, Masayoshi</creator><creator>Kobayashi, Atsushi</creator><creator>Suzuki, Hitoshi</creator><creator>Ishida, Takafumi</creator><creator>Takeishi, Yasuchika</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6588-0764</orcidid><orcidid>https://orcid.org/0000-0001-5726-3926</orcidid></search><sort><creationdate>201809</creationdate><title>Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients</title><author>Yamada, Shinya ; Yoshihisa, Akiomi ; Sato, Yu ; Sato, Takamasa ; Kamioka, Masashi ; Kaneshiro, Takashi ; Oikawa, Masayoshi ; Kobayashi, Atsushi ; Suzuki, Hitoshi ; Ishida, Takafumi ; Takeishi, Yasuchika</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-25c251cb2fd9494e142f54f40c6cab39a7d08ea18332dd038375d5c40c051b293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>cardiac death</topic><topic>Death</topic><topic>EKG</topic><topic>Electrocardiography</topic><topic>Health risk assessment</topic><topic>Heart diseases</topic><topic>Heart failure</topic><topic>Heart rate</topic><topic>Heart rate turbulence</topic><topic>Holter monitoring</topic><topic>Males</topic><topic>T‐wave alternans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yamada, Shinya</creatorcontrib><creatorcontrib>Yoshihisa, Akiomi</creatorcontrib><creatorcontrib>Sato, Yu</creatorcontrib><creatorcontrib>Sato, Takamasa</creatorcontrib><creatorcontrib>Kamioka, Masashi</creatorcontrib><creatorcontrib>Kaneshiro, Takashi</creatorcontrib><creatorcontrib>Oikawa, Masayoshi</creatorcontrib><creatorcontrib>Kobayashi, Atsushi</creatorcontrib><creatorcontrib>Suzuki, Hitoshi</creatorcontrib><creatorcontrib>Ishida, Takafumi</creatorcontrib><creatorcontrib>Takeishi, Yasuchika</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yamada, Shinya</au><au>Yoshihisa, Akiomi</au><au>Sato, Yu</au><au>Sato, Takamasa</au><au>Kamioka, Masashi</au><au>Kaneshiro, Takashi</au><au>Oikawa, Masayoshi</au><au>Kobayashi, Atsushi</au><au>Suzuki, Hitoshi</au><au>Ishida, Takafumi</au><au>Takeishi, Yasuchika</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2018-09</date><risdate>2018</risdate><volume>29</volume><issue>9</issue><spage>1257</spage><epage>1264</epage><pages>1257-1264</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Background
Heart failure (HF) patients have a higher risk of recurrent HF and cardiac death, and electrical remodeling is considered to be an important factor for HF progression. The present study aimed to validate the utility of electrocardiogram and Holter monitoring for the risk stratification of HF patients.
Methods
Our study comprised 215 patients (144 males, mean age 62 years) who had been hospitalized due to acute decompensated HF. Electrocardiogram (QRS duration and QTc interval) and 24‐hour Holter monitoring (heart rate variability, heart rate turbulence, and T‐wave alternans [TWA]) were performed in stable condition before discharge. The clinical characteristics and outcomes were then investigated.
Results
During a median follow‐up period of 2.7 years, there were 83 (38.6%) cardiac events (rehospitalization due to worsening HF [n = 51] or cardiac death [n = 32]). The patients with cardiac events had a lower turbulence slope (TS) and higher TWA compared to those without cardiac events (TS, 3.0 ± 5.5 ms/RR vs. 5.3 ± 5.6 ms/RR, P = 0.001; TWA, 66.1 ± 19.6 μV vs. 54.7 ± 15.1 μV, P < 0.001). Univariable analysis showed that TS, TWA, QRS duration, and QTc interval were associated with cardiac events (P = 0.004, P < 0.001, P = 0.037, and P = 0.024, respectively), while the multivariable analysis after the adjustment of multiple confounders showed that TS and TWA were independent predictive factors of cardiac events with a hazard ratio of 0.936 and 1.015 (95% confidence interval [CI]: 0.860–0.974, P = 0.006; and 95% CI: 1.003–1.027, P = 0.016), respectively.
Conclusion
The measurement of TS and TWA is useful for assessing risk for rehospitalization and cardiac death in HF patients.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29777559</pmid><doi>10.1111/jce.13639</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6588-0764</orcidid><orcidid>https://orcid.org/0000-0001-5726-3926</orcidid></addata></record> |
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| subjects | cardiac death Death EKG Electrocardiography Health risk assessment Heart diseases Heart failure Heart rate Heart rate turbulence Holter monitoring Males T‐wave alternans |
| title | Utility of heart rate turbulence and T‐wave alternans to assess risk for readmission and cardiac death in hospitalized heart failure patients |
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