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

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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
Publication statusAccepted/In press - Jan 1 2019



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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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