Myocardial electrical instability score: clinical and prognostic significance
Open Access
- 28 December 2019
- journal article
- Published by Silicea - Poligraf, LLC in Russian Journal of Cardiology
- No. 12,p. 55-61
- https://doi.org/10.15829/1560-4071-2019-12-55-61
Abstract
Aim. To develop and test a risk-stratification model for patients with coronary artery disease (CAD) and non-ischemic pathologies based on a computer analysis of electrical instability ECG markers.Material and methods. In the period from 2011 to 2018, the study included 1014 patients with CAD and non-ischemic pathologies. Depending on ventricular arrhythmia status, the analyzed cohort was divided into 3 groups: 1) 644 patients without lifethreatening ventricular tachyarrhythmias (-VTA), mean age 51,7±16,1 years; 2) 280 patients with clinically significant ventricular arrhythmias (+csVA): ventricular extrasystoles (VES) >1500/24 h, coupled VES >50/24 h or unstable ventricular tachycardia (uVT), mean age 46,7±14,0 years; 3) 90 patients with life-threatening ventricular tachyarrhythmias (+VTA): persistent VT (pVT), successful cardiopulmonary resuscitation (CPR), appropriate discharges by implanted cardioverter defibrillator (CVD), sudden cardiac death (SCD), mean age 46,8±12,7 years.Using the Intekard 7.3 software, ECG markers of myocardial electrical instability were analyzed: T wave alternation, QT interval and dispersion, fragmented QRS, spatial QRS-T angle, turbulence onset and slope, and heart rate deceleration/acceleration.Results. Statistically significant differences were found between the values of T wave alternation, QT interval, fragmented QRS and QRS-T angle in groups 1 and 3 (-VTA) and (+VTA), pPersonalized model was formed for predicting the risk of life-threatening VTA (primary endpoints: pVT, appropriate CVD discharges, CPR, SCD) in patients with CAD and non-ischemic pathologies (cardiomyopathy, channelopathy) in 5 years follow-up. Integral score of myocardial electrical instability is proposed as new quantitative parameter for risk stratification (sensitivity 75%, specificity 78%, accuracy 77%).Conclusion. The myocardial electrical instability score provides the individual assessment of the dynamic SCD risk. The Intekard 7.3 software is a simple, economic and accessible ECG tool for arrhythmia monitoring.Keywords
This publication has 7 references indexed in Scilit:
- 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summaryHeart Rhythm, 2017
- 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac deathEuropean Heart Journal, 2015
- Risk stratification for sudden cardiac death: current status and challenges for the futureEuropean Heart Journal, 2014
- Risk Stratification in Acute Heart FailureCanadian Journal of Cardiology, 2014
- Significance of a Fragmented QRS Complex Versus a Q Wave in Patients With Coronary Artery DiseaseJournal of the American College of Cardiology, 2006
- The Seattle Heart Failure ModelJournal of the American College of Cardiology, 2006
- The importance of total cardiovascular risk assessment in clinical practiceThe European Journal of General Practice, 2006