Temporal changes of noninvasive electrocardiographic risk factors for sudden cardiac death in post-myocardial infarction patients with preserved ejection fraction: Insights from the PRESERVE-EF study

Iosif Xenogiannis, Konstantinos A. Gatzoulis, Panagiota Flevari, Ignatios Ikonomidis, Efstathios Iliodromitis, Konstantinos Trachanas, Konstantinos Vlachos, Petros Arsenos, Dimitrios Tsiachris, Dimitrios Tousoulis, Emmanouil S. Brilakis, Dimitrios Alexopoulos

Research output: Contribution to journalArticle

Abstract

Background: Several noninvasive risk factors (NIRFs) have been proposed for sudden cardiac death risk stratification in post-myocardial infarction (post-MI) patients with preserved ejection fraction (EF). However, it remains unclear if these factors change over time. Methods: We evaluated seven electrocardiographic NIRFs as they were described in the PRESERVE-EF trial in 80 post-MI patients with EF ≥ 40%, at least 40 days after revascularization and 1 year later. Results: Mean patient age was 56 ± 10 years, and 88% were men. Mean EF was 50 ± 5%. The prevalence of (a) positive late potentials (27.5% vs. 28.8%, p =.860), (b) >30 premature ventricular complexes/hour (8.8% vs. 11.3%, p =.598), (c) nonsustained ventricular tachycardia (8.8% vs. 5%, p =.349), (d) standard deviation of normal RR intervals <75 ms (3.8% vs. 3.8%, p = 1.000), (e) QTc derived from 24-hr electrocardiography >440 ms (men) or >450 ms (women) (17.5% vs. 17.5%, p = 1.000), (f) deceleration capacity ≤4.5 ms and heart rate turbulence onset ≥0% and slope ≤2.5 ms (2.5% vs. 3.8%. p = 1.000), and (g) ambulatory T-wave alternans ≥65 μV in two Holter channels (6.3% vs. 6.3%, p = 1.000) were similar between the two measurements. However, five patients (6.3%) without any NIRFs during the first assessment had at least one positive NIRF at the second assessment and six patients (7.5%) with at least one NIRF at baseline had no positive NIRFs at 1 year. Conclusions: While the prevalence of the examined electrocardiographic NIRFs between the two examinations was similar on a population basis, some patients without NIRFs at baseline developed NIRFs at 1 year and vice versa, highlighting the need for risk factor reassessment during follow-up.

Original languageEnglish (US)
Article numbere12701
JournalAnnals of Noninvasive Electrocardiology
DOIs
StateAccepted/In press - Jan 1 2019

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Sudden Cardiac Death
Myocardial Infarction
Ventricular Premature Complexes
Deceleration
Ventricular Tachycardia
Heart Rate

Keywords

  • myocardial infarction
  • noninvasive risk factors
  • preserved EF
  • sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Temporal changes of noninvasive electrocardiographic risk factors for sudden cardiac death in post-myocardial infarction patients with preserved ejection fraction : Insights from the PRESERVE-EF study. / Xenogiannis, Iosif; Gatzoulis, Konstantinos A.; Flevari, Panagiota; Ikonomidis, Ignatios; Iliodromitis, Efstathios; Trachanas, Konstantinos; Vlachos, Konstantinos; Arsenos, Petros; Tsiachris, Dimitrios; Tousoulis, Dimitrios; Brilakis, Emmanouil S.; Alexopoulos, Dimitrios.

In: Annals of Noninvasive Electrocardiology, 01.01.2019.

Research output: Contribution to journalArticle

Xenogiannis, Iosif ; Gatzoulis, Konstantinos A. ; Flevari, Panagiota ; Ikonomidis, Ignatios ; Iliodromitis, Efstathios ; Trachanas, Konstantinos ; Vlachos, Konstantinos ; Arsenos, Petros ; Tsiachris, Dimitrios ; Tousoulis, Dimitrios ; Brilakis, Emmanouil S. ; Alexopoulos, Dimitrios. / Temporal changes of noninvasive electrocardiographic risk factors for sudden cardiac death in post-myocardial infarction patients with preserved ejection fraction : Insights from the PRESERVE-EF study. In: Annals of Noninvasive Electrocardiology. 2019.
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title = "Temporal changes of noninvasive electrocardiographic risk factors for sudden cardiac death in post-myocardial infarction patients with preserved ejection fraction: Insights from the PRESERVE-EF study",
abstract = "Background: Several noninvasive risk factors (NIRFs) have been proposed for sudden cardiac death risk stratification in post-myocardial infarction (post-MI) patients with preserved ejection fraction (EF). However, it remains unclear if these factors change over time. Methods: We evaluated seven electrocardiographic NIRFs as they were described in the PRESERVE-EF trial in 80 post-MI patients with EF ≥ 40{\%}, at least 40 days after revascularization and 1 year later. Results: Mean patient age was 56 ± 10 years, and 88{\%} were men. Mean EF was 50 ± 5{\%}. The prevalence of (a) positive late potentials (27.5{\%} vs. 28.8{\%}, p =.860), (b) >30 premature ventricular complexes/hour (8.8{\%} vs. 11.3{\%}, p =.598), (c) nonsustained ventricular tachycardia (8.8{\%} vs. 5{\%}, p =.349), (d) standard deviation of normal RR intervals <75 ms (3.8{\%} vs. 3.8{\%}, p = 1.000), (e) QTc derived from 24-hr electrocardiography >440 ms (men) or >450 ms (women) (17.5{\%} vs. 17.5{\%}, p = 1.000), (f) deceleration capacity ≤4.5 ms and heart rate turbulence onset ≥0{\%} and slope ≤2.5 ms (2.5{\%} vs. 3.8{\%}. p = 1.000), and (g) ambulatory T-wave alternans ≥65 μV in two Holter channels (6.3{\%} vs. 6.3{\%}, p = 1.000) were similar between the two measurements. However, five patients (6.3{\%}) without any NIRFs during the first assessment had at least one positive NIRF at the second assessment and six patients (7.5{\%}) with at least one NIRF at baseline had no positive NIRFs at 1 year. Conclusions: While the prevalence of the examined electrocardiographic NIRFs between the two examinations was similar on a population basis, some patients without NIRFs at baseline developed NIRFs at 1 year and vice versa, highlighting the need for risk factor reassessment during follow-up.",
keywords = "myocardial infarction, noninvasive risk factors, preserved EF, sudden cardiac death",
author = "Iosif Xenogiannis and Gatzoulis, {Konstantinos A.} and Panagiota Flevari and Ignatios Ikonomidis and Efstathios Iliodromitis and Konstantinos Trachanas and Konstantinos Vlachos and Petros Arsenos and Dimitrios Tsiachris and Dimitrios Tousoulis and Brilakis, {Emmanouil S.} and Dimitrios Alexopoulos",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/anec.12701",
language = "English (US)",
journal = "Annals of Noninvasive Electrocardiology",
issn = "1082-720X",
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T1 - Temporal changes of noninvasive electrocardiographic risk factors for sudden cardiac death in post-myocardial infarction patients with preserved ejection fraction

T2 - Insights from the PRESERVE-EF study

AU - Xenogiannis, Iosif

AU - Gatzoulis, Konstantinos A.

AU - Flevari, Panagiota

AU - Ikonomidis, Ignatios

AU - Iliodromitis, Efstathios

AU - Trachanas, Konstantinos

AU - Vlachos, Konstantinos

AU - Arsenos, Petros

AU - Tsiachris, Dimitrios

AU - Tousoulis, Dimitrios

AU - Brilakis, Emmanouil S.

AU - Alexopoulos, Dimitrios

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Several noninvasive risk factors (NIRFs) have been proposed for sudden cardiac death risk stratification in post-myocardial infarction (post-MI) patients with preserved ejection fraction (EF). However, it remains unclear if these factors change over time. Methods: We evaluated seven electrocardiographic NIRFs as they were described in the PRESERVE-EF trial in 80 post-MI patients with EF ≥ 40%, at least 40 days after revascularization and 1 year later. Results: Mean patient age was 56 ± 10 years, and 88% were men. Mean EF was 50 ± 5%. The prevalence of (a) positive late potentials (27.5% vs. 28.8%, p =.860), (b) >30 premature ventricular complexes/hour (8.8% vs. 11.3%, p =.598), (c) nonsustained ventricular tachycardia (8.8% vs. 5%, p =.349), (d) standard deviation of normal RR intervals <75 ms (3.8% vs. 3.8%, p = 1.000), (e) QTc derived from 24-hr electrocardiography >440 ms (men) or >450 ms (women) (17.5% vs. 17.5%, p = 1.000), (f) deceleration capacity ≤4.5 ms and heart rate turbulence onset ≥0% and slope ≤2.5 ms (2.5% vs. 3.8%. p = 1.000), and (g) ambulatory T-wave alternans ≥65 μV in two Holter channels (6.3% vs. 6.3%, p = 1.000) were similar between the two measurements. However, five patients (6.3%) without any NIRFs during the first assessment had at least one positive NIRF at the second assessment and six patients (7.5%) with at least one NIRF at baseline had no positive NIRFs at 1 year. Conclusions: While the prevalence of the examined electrocardiographic NIRFs between the two examinations was similar on a population basis, some patients without NIRFs at baseline developed NIRFs at 1 year and vice versa, highlighting the need for risk factor reassessment during follow-up.

AB - Background: Several noninvasive risk factors (NIRFs) have been proposed for sudden cardiac death risk stratification in post-myocardial infarction (post-MI) patients with preserved ejection fraction (EF). However, it remains unclear if these factors change over time. Methods: We evaluated seven electrocardiographic NIRFs as they were described in the PRESERVE-EF trial in 80 post-MI patients with EF ≥ 40%, at least 40 days after revascularization and 1 year later. Results: Mean patient age was 56 ± 10 years, and 88% were men. Mean EF was 50 ± 5%. The prevalence of (a) positive late potentials (27.5% vs. 28.8%, p =.860), (b) >30 premature ventricular complexes/hour (8.8% vs. 11.3%, p =.598), (c) nonsustained ventricular tachycardia (8.8% vs. 5%, p =.349), (d) standard deviation of normal RR intervals <75 ms (3.8% vs. 3.8%, p = 1.000), (e) QTc derived from 24-hr electrocardiography >440 ms (men) or >450 ms (women) (17.5% vs. 17.5%, p = 1.000), (f) deceleration capacity ≤4.5 ms and heart rate turbulence onset ≥0% and slope ≤2.5 ms (2.5% vs. 3.8%. p = 1.000), and (g) ambulatory T-wave alternans ≥65 μV in two Holter channels (6.3% vs. 6.3%, p = 1.000) were similar between the two measurements. However, five patients (6.3%) without any NIRFs during the first assessment had at least one positive NIRF at the second assessment and six patients (7.5%) with at least one NIRF at baseline had no positive NIRFs at 1 year. Conclusions: While the prevalence of the examined electrocardiographic NIRFs between the two examinations was similar on a population basis, some patients without NIRFs at baseline developed NIRFs at 1 year and vice versa, highlighting the need for risk factor reassessment during follow-up.

KW - myocardial infarction

KW - noninvasive risk factors

KW - preserved EF

KW - sudden cardiac death

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