Ventricular Repolarization Dynamicity Provides Independent Prognostic Information Toward Major Arrhythmic Events in Patients With Idiopathic Dilated Cardiomyopathy
Open accessAbstract
Objectives The purpose of this work was to evaluate whether ventricular repolarization dynamicity predicts major arrhythmic events in patients with idiopathic dilated cardiomyopathy (DCM).Background Arrhythmic risk stratification in patients with DCM is still an open issue. Ventricular repolarization analysis should provide relevant information, but QT interval and QT dispersion failed in predicting arrhythmic risk.Methods The following parameters were evaluated in 179 consecutive DCM patients without history of sustained ventricular tachycardia (VT) and/or ventricular fibrillation (VF) at enrollment: QRS duration, QT interval corrected for heart rate, and QT dispersion at electrocardiogram (ECG); left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter at echocardiogram; and nonsustained ventricular tachycardia (NSVT), heart rate variability (standard deviation of RR intervals), and ventricular repolarization dynamicity as measured by means of 24-h ECG monitoring, by calculating the slope of linear regression analysis of QT end and RR intervals (QTe-slope) and the value of mean QT end corrected for heart rate.Results During a mean follow-up of 39 months, 9 patients died suddenly and 15 experienced VT and/or VF. At multivariate analysis, LVEF (p = 0.047), NSVT (p = 0.022), and QTe-slope (p = 0.034) were significantly associated with arrhythmic events. Among the patients with a low LVEF, NSVT and/or steeper QTe-slope identified a subgroup at highest arrhythmic risk.Conclusions In patients with DCM, QT dynamicity is independently associated with the occurrence of major arrhythmic events and improves the predictive accuracy of stratifying arrhythmic risk of these patients.
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In NIDCM, the prognostic value of AECG is rather low and remains controversial.
“in contradistinction to what is reported in patients with ischemic cardiomyopathy, the prognostic value of AECG in NIDCM is rather low and remains controversial”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Goldberger et al., 2007
The Abstract and Discussion report that QT dynamicity measured by 24-hour ECG independently predicts major arrhythmic events in dilated cardiomyopathy and improves risk prediction; the Discussion also identifies nonsustained ventricular tachycardia as an independent predictor. Although the paper calls risk stratification an open issue, its findings run contrary to the blanket claim that ambulatory ECG has rather low prognostic value in this population. Page numbers are unavailable in our copy. (LLM, conf=0.87)
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Experimental — accuracy not yet measuredNSVT was associated with threefold higher risk of arrhythmic events during follow-up, and its prognostic value was enhanced by combination with low LVEF and abnormal QT dynamics.
“Iacoviello et al. (2007) found that NSVT was associated with threefold higher risk of arrhythmic events during follow-up and that prognostic value of NSVT was enhanced by a combination with low LVEF and abnormal QT dynamics.”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Iacoviello et al., 2007
The Clinical correlates of QT dynamicity section reports that NSVT predicted major arrhythmic events and that combining NSVT with low LVEF and a steeper QTe-slope improved risk stratification. The Discussion (p. 230) likewise reports greater predictive value when these measures were combined. The passages do not establish the claimed threefold increase in risk specifically associated with NSVT. (LLM, conf=0.85)
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The Year of 2007 in Electrocardiology
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Highlights of the Year in JACC 2007
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- Authors
- Iacoviello, M., Forleo, C., Guida, P., Romito, R., Sorgente, A., Sorrentino, S., Catucci, S., Mastropasqua, F., & Pitzalis, M.
- Affiliations
- University of Bari Aldo Moro (IT)
- Fondazione Salvatore Maugeri (IT)
- East Carolina University (US)
- Corresponding author
- Iacoviello, Massimo
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2007-07
- Volume
- 50
- Issue
- 3
- Pages
- 225-231
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2075503497
- Cited by
- 78
- References
- 33
- Citations by year
- 2026: 3 · 2023: 1 · 2021: 3 · 2020: 1 · 2019: 4 · 2018: 3 · 2017: 5 · 2016: 5 · 2015: 4 · 2014: 10 · 2013: 6 · 2012: 7
- FWCI
- 4.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- idiopathic dilated cardiomyopathy, arrhythmic risk stratification, sudden cardiac death, non-sustained ventricular tachycardia, ventricular fibrillation, left ventricular ejection fraction, QT dispersion, heart rate variability
- MeSH terms
- Adult, Cardiomyopathy, Dilated, Electrocardiography, Female, Humans, Long QT Syndrome, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Sensitivity and Specificity, Severity of Illness Index, Stroke Volume, Echocardiography, Doppler, Cohort Studies, Electrocardiography, Ambulatory, Linear Models, Survival Analysis, Death, Sudden, Cardiac, Tachycardia, Ventricular, Risk Assessment, Ventricular Remodeling
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