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Type: Journal article
Title: Augmented oscillations in QT interval duration predict mortality post myocardial infarction independent of heart rate
Author: El-Hamad, F.J.
Bonabi, S.Y.
Müller, A.
Steger, A.
Schmidt, G.
Baumert, M.
Citation: Frontiers in Physiology, 2020; 11:578173-578173
Publisher: Frontiers Media
Issue Date: 2020
ISSN: 1664-042X
Statement of
Fatima J. El-Hamad, Safa Y. Bonabi, Alexander Müller, Alexander Steger, Georg Schmidt and Mathias Baumert
Abstract: Objective:This study seeks to decompose QT variability (QTV) into physiological sources and assess their role for risk stratification in patients post myocardial infarction (MI). We hypothesize that the magnitude of QTV that cannot be explained by heart rate or respiration carries important prognostic information. Background:Elevated beat-to-beat QTV is predictive of cardiac mortality, but the underlying mechanisms, and hence its interpretation, remain opaque. Methods:We decomposed the QTV of 895 patients post MI into contributions by heart rate, respiration, and unexplained sources. Results:Cox proportional hazard analysis demonstrates that augmented oscillations in QTV and their level of dissociation from heart rate are associated with a higher 5-year mortality rate (18.4% vs. 4.7%, p < 0.0001). In patients with left ventricular ejection fraction (LVEF) > 35%, a higher QTV risk score was associated with a significantly higher 5-year mortality rate (16% vs. 4%, p < 0.0001). In patients with a GRACE score ≥ 120, a higher QTV risk score was associated with a significantly higher 5-year mortality (25% vs. 11%, p < 0.001). Conclusion:Augmented oscillations in QTV and discordance from heart rate, possibly indicative of excessive sympathetic outflow to the ventricular myocardium, predict high risk in patients post MI independent from established risk markers. Clinical Trial, identifier NCT00196274.
Keywords: autoregressive model
cardiovascular disease
myocardial infarction
repolarization variability
risk stratification
sudden death
Rights: © 2020 El-Hamad, Bonabi, Müller, Steger, Schmidt and Baumert. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
DOI: 10.3389/fphys.2020.578173
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