© 2005 European Society of Cardiology
QT dynamicity: a prognostic factor for sudden cardiac death in chronic heart failure
a CESNA (Club d'Etude du Systrme Nerveux Autonome) et INSERM U586, Laboratoire de Pharmacologie médicale et clinique, Faculté de Médecine 37 allés Jules Guesde, 31073 Toulouse Cedex, France
b Fédération des Services de Cardiologie, Centre Hospitalier Universitaire de Rangueil 1 avenue Jean Poulhès, 31403 Toulouse, France
c Unité de Formation et de Recherche en Sciences et Techniques des Activités Physiques et Sportives (UFRSTAPS), Université Paul Sabatier 118 route de Narbonne, 31062 Toulouse Cedex 4, France
d Clinique de réadaptation cardio-vasculaire et pulmonaire de St Orens 12 avenue de Revel, 31650 St Orens, France
e Heart Rate Variability Laboratory, Cardiovascular Division, Washington University School of Medicine USA
* Corresponding author. Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, 37 allés Jules Guesde, 31073 Toulouse Cedex, France. Tel.: +33 5 61 14 59 64; fax: +33 5 61 25 51 12. E-mail address: pathak{at}cict.fr
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Abstract |
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Introduction: The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate predicts sudden death in patients with chronic heart failure (CHF).
Methods: We prospectively included 175 CHF patients in sinus rhythm. QT dynamicity was evaluated by analyzing 24-h Holter recordings. The linear regression slope of QT interval measured to the apex and to the end of T wave plotted against RR intervals was calculated using a dedicated Holter algorithm.
Results: Mean follow-up was 29.9±17.9 months. There were 48 deaths, of which 21 were sudden. The actuarial 3-year mortality rates were 38.4% for overall mortality and 14.1% for sudden death. Of all the parameters, an increased QTe/RR slope (>0.28) was the strongest independent predictor of sudden death (relative risk 3.47, 95% confidence interval 1.43–8.40, p=0.006).
Conclusion: Increased 24-h QTe dynamicity is independently predictive of sudden death among patients with heart failure. This simple parameter may help to stratify risk and select patients who may benefit from antiarrhythmic prophylaxis.
Received June 25, 2004; Revised September 27, 2004; Accepted October 20, 2004
1 Daniel Curnier and Atul Pathak both contributed equally to this work.
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