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T-wave morphology restitution dependency with heart rate range and its association with sudden cardiac death in chronic heart failure

Abstract:

The index of T-wave morphology restitution (TMR) has recently been presented as a sudden cardiac death (SCD) pbkp_redictor in a population of chronic heart failure (CHF) patients. This index quantifies the level of variation in the T-wave morphology per RR interval (RRI) increment. The impact of using different definitions of ranges of RRI (Delta;RRI) and the study of the interaction between TMR and Delta;RRI are relevant for both the optimization and the mechanistic interpretation of the index. This study aims to investigate the interaction between Delta;RRI and TMR and to assess whether different definitions of Delta;RRI (patients-independent or patient-specific) may affect the pbkp_redictive value of TMR. Holter ECG recordings from 651 patients with CHF, including SCD, victims of other causes and survivors, were analyzed. Mann-Whitney test was used to evaluate significant differences between SCD victims and the rest of patients. In the patient-independent analysis, TMR values only showed significant differences when 0.25s≤ Delta;RR≤0.3s, while in the patient-specific analysis TMR values were significantly different when Delta;RR≥0.6 of the maximum RR range, Delta;RRmax. In conclusion, the index TMR is a pbkp_redictor of SCD robust to variations in Delta;RR values evaluated in segments comprising at least 0.6 of Delta;RRmax.