QT variability index on 24-hour Holter independently predicts mortality in patients with heart failure

Analysis of Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca (GISSI-HF) trial

Craig P. Dobson, Maria Teresa La Rovere, Gian Domenico Pinna, Robert Goldstein, Cara Olsen, Marino Bernardinangeli, Marco Veniani, Paolo Midi, Luigi Tavazzi, Mark Haigney

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Increased temporal variability of repolarization, as reflected by QT interval variability measured over 1015 minutes, predicted spontaneous ventricular arrhythmias and death in implantable cardioverter-defibrillator patients in mild to moderate heart failure (HF). Objective: The purpose of this study was to test our hypothesis that increased mean QT variability over 24 hours would be associated with increased cardiovascular (CV) mortality in a heterogeneous HF population. Methods: The Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure trial prospectively enrolled subjects with HF of any cause. Twenty-four-hour Holter recordings from 268 subjects were analyzed using a template-matching, semiautomatic algorithm to measure QT and heart rate time series in sequential 5-minute epochs over 24 hours. The QT variability index (QTVI) was expressed as the log ratio of the normalized QT variance over normalized heart rate variance. Total and CV mortality were assessed as a function of continuous and dichotomous QTVI (>-0.84) in univariate and multivariable Cox proportional hazards models, adjusting for significant clinical predictors. Results: After a median of 47 months, there were 53 deaths, of which 44 were from CV causes. A significant association with the outcome was found for QTVI both as continuous and dichotomous variables after adjustment for clinical covariates (age >70, New York Heart Association class IIIIV, left ventricular ejection fraction, nonsustained ventricular tachycardia, creatinine): QTVI hazard ratio (HR) 4.0 (confidence interval [CI] 1.888; P =.008) for total and 4.4 (CI 1.910.1; P =.0006) for CV mortality; QTVI >-0.84 HR 2.0 (CI 1.13.6; P =.02) for total and 2.1 (CI 1.13.8; P =.02) for CV mortality. Conclusion: Increased repolarization lability, as reflected in QTVI measured over 24 hours, is associated with increased risk for total and CV mortality in a heterogeneous population with chronic HF.

Original languageEnglish
Pages (from-to)1237-1242
Number of pages6
JournalHeart Rhythm
Volume8
Issue number8
DOIs
Publication statusPublished - Aug 2011

Fingerprint

Heart Failure
Mortality
Confidence Intervals
Heart Rate
Implantable Defibrillators
Ventricular Tachycardia
Proportional Hazards Models
Stroke Volume
Population
Cardiac Arrhythmias
Creatinine

Keywords

  • cardiovascular mortality
  • heart failure
  • QT
  • QT variability
  • Repolarization
  • U wave

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

QT variability index on 24-hour Holter independently predicts mortality in patients with heart failure : Analysis of Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca (GISSI-HF) trial. / Dobson, Craig P.; La Rovere, Maria Teresa; Pinna, Gian Domenico; Goldstein, Robert; Olsen, Cara; Bernardinangeli, Marino; Veniani, Marco; Midi, Paolo; Tavazzi, Luigi; Haigney, Mark.

In: Heart Rhythm, Vol. 8, No. 8, 08.2011, p. 1237-1242.

Research output: Contribution to journalArticle

Dobson, Craig P. ; La Rovere, Maria Teresa ; Pinna, Gian Domenico ; Goldstein, Robert ; Olsen, Cara ; Bernardinangeli, Marino ; Veniani, Marco ; Midi, Paolo ; Tavazzi, Luigi ; Haigney, Mark. / QT variability index on 24-hour Holter independently predicts mortality in patients with heart failure : Analysis of Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca (GISSI-HF) trial. In: Heart Rhythm. 2011 ; Vol. 8, No. 8. pp. 1237-1242.
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abstract = "Background: Increased temporal variability of repolarization, as reflected by QT interval variability measured over 1015 minutes, predicted spontaneous ventricular arrhythmias and death in implantable cardioverter-defibrillator patients in mild to moderate heart failure (HF). Objective: The purpose of this study was to test our hypothesis that increased mean QT variability over 24 hours would be associated with increased cardiovascular (CV) mortality in a heterogeneous HF population. Methods: The Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure trial prospectively enrolled subjects with HF of any cause. Twenty-four-hour Holter recordings from 268 subjects were analyzed using a template-matching, semiautomatic algorithm to measure QT and heart rate time series in sequential 5-minute epochs over 24 hours. The QT variability index (QTVI) was expressed as the log ratio of the normalized QT variance over normalized heart rate variance. Total and CV mortality were assessed as a function of continuous and dichotomous QTVI (>-0.84) in univariate and multivariable Cox proportional hazards models, adjusting for significant clinical predictors. Results: After a median of 47 months, there were 53 deaths, of which 44 were from CV causes. A significant association with the outcome was found for QTVI both as continuous and dichotomous variables after adjustment for clinical covariates (age >70, New York Heart Association class IIIIV, left ventricular ejection fraction, nonsustained ventricular tachycardia, creatinine): QTVI hazard ratio (HR) 4.0 (confidence interval [CI] 1.888; P =.008) for total and 4.4 (CI 1.910.1; P =.0006) for CV mortality; QTVI >-0.84 HR 2.0 (CI 1.13.6; P =.02) for total and 2.1 (CI 1.13.8; P =.02) for CV mortality. Conclusion: Increased repolarization lability, as reflected in QTVI measured over 24 hours, is associated with increased risk for total and CV mortality in a heterogeneous population with chronic HF.",
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AU - Dobson, Craig P.

AU - La Rovere, Maria Teresa

AU - Pinna, Gian Domenico

AU - Goldstein, Robert

AU - Olsen, Cara

AU - Bernardinangeli, Marino

AU - Veniani, Marco

AU - Midi, Paolo

AU - Tavazzi, Luigi

AU - Haigney, Mark

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N2 - Background: Increased temporal variability of repolarization, as reflected by QT interval variability measured over 1015 minutes, predicted spontaneous ventricular arrhythmias and death in implantable cardioverter-defibrillator patients in mild to moderate heart failure (HF). Objective: The purpose of this study was to test our hypothesis that increased mean QT variability over 24 hours would be associated with increased cardiovascular (CV) mortality in a heterogeneous HF population. Methods: The Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure trial prospectively enrolled subjects with HF of any cause. Twenty-four-hour Holter recordings from 268 subjects were analyzed using a template-matching, semiautomatic algorithm to measure QT and heart rate time series in sequential 5-minute epochs over 24 hours. The QT variability index (QTVI) was expressed as the log ratio of the normalized QT variance over normalized heart rate variance. Total and CV mortality were assessed as a function of continuous and dichotomous QTVI (>-0.84) in univariate and multivariable Cox proportional hazards models, adjusting for significant clinical predictors. Results: After a median of 47 months, there were 53 deaths, of which 44 were from CV causes. A significant association with the outcome was found for QTVI both as continuous and dichotomous variables after adjustment for clinical covariates (age >70, New York Heart Association class IIIIV, left ventricular ejection fraction, nonsustained ventricular tachycardia, creatinine): QTVI hazard ratio (HR) 4.0 (confidence interval [CI] 1.888; P =.008) for total and 4.4 (CI 1.910.1; P =.0006) for CV mortality; QTVI >-0.84 HR 2.0 (CI 1.13.6; P =.02) for total and 2.1 (CI 1.13.8; P =.02) for CV mortality. Conclusion: Increased repolarization lability, as reflected in QTVI measured over 24 hours, is associated with increased risk for total and CV mortality in a heterogeneous population with chronic HF.

AB - Background: Increased temporal variability of repolarization, as reflected by QT interval variability measured over 1015 minutes, predicted spontaneous ventricular arrhythmias and death in implantable cardioverter-defibrillator patients in mild to moderate heart failure (HF). Objective: The purpose of this study was to test our hypothesis that increased mean QT variability over 24 hours would be associated with increased cardiovascular (CV) mortality in a heterogeneous HF population. Methods: The Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure trial prospectively enrolled subjects with HF of any cause. Twenty-four-hour Holter recordings from 268 subjects were analyzed using a template-matching, semiautomatic algorithm to measure QT and heart rate time series in sequential 5-minute epochs over 24 hours. The QT variability index (QTVI) was expressed as the log ratio of the normalized QT variance over normalized heart rate variance. Total and CV mortality were assessed as a function of continuous and dichotomous QTVI (>-0.84) in univariate and multivariable Cox proportional hazards models, adjusting for significant clinical predictors. Results: After a median of 47 months, there were 53 deaths, of which 44 were from CV causes. A significant association with the outcome was found for QTVI both as continuous and dichotomous variables after adjustment for clinical covariates (age >70, New York Heart Association class IIIIV, left ventricular ejection fraction, nonsustained ventricular tachycardia, creatinine): QTVI hazard ratio (HR) 4.0 (confidence interval [CI] 1.888; P =.008) for total and 4.4 (CI 1.910.1; P =.0006) for CV mortality; QTVI >-0.84 HR 2.0 (CI 1.13.6; P =.02) for total and 2.1 (CI 1.13.8; P =.02) for CV mortality. Conclusion: Increased repolarization lability, as reflected in QTVI measured over 24 hours, is associated with increased risk for total and CV mortality in a heterogeneous population with chronic HF.

KW - cardiovascular mortality

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KW - QT

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KW - U wave

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