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T wave alternans extracted from 30-minute short resting Holter ECG recordings predicts mortality in heart failure.

P. Arsenos,K. Gatzoulis,P. Dilaveris,S. Sideris,D. Tousoulis

Published 2018 in Journal of Electrocardiology

ABSTRACT

BACKGROUND We extracted T Wave Alternans (TWA) from a 30 minute Short Resting Holter ECG (SRH ECG) in the supine position, as a Total Mortality (TM) predictor in Heart Failure (HF). METHODS Signals from 146 HF patients (LVEF = 33 ± 10%), were analyzed with Modified Moving Average method. After 42.1 months, 26 patients died. RESULTS (Deceased vs Living group): TWA:31 ± 18 μV vs 25 ± 13 μV(p = 0.05), LVEF:32 ± 10% vs 34 ± 9% (p = 0.5), Heart Rate:73 ± 11 bpm vs 69 ± 12 bpm (p = 0.2), SDNN/HRV:45 ± 42 ms vs 41 ± 29 ms (p = 0.4), QRS:123 ± 26 ms vs 119 ± 29 ms (p = 0.5).Cox regression model adjusted for TWA, LVEF and QRS, revealed that the TWA was an independent TM predictor (H.R.: 1.022, 95% C.I.: 0.999-1.046, p = 0.05).The TWA ≥ 42 μV demonstrated HR: 2.521, (95% C.I.: 0.982-6.472, p = 0.05). CONCLUSIONS In severely affected HF patients, TWA from a SRH ECG may be present even during slow resting heart rates and proved to be an important and independent TM predictor. The SRH ECG recording is an efficient and fast method for mortality risk evaluation in HF patients.

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