scholarly journals Myocardial electrical instability score: clinical and prognostic significance

2019 ◽  
pp. 55-61 ◽  
Author(s):  
A. V. Frolov ◽  
T. G. Vaykhanskaya ◽  
O. P. Melnikova ◽  
A. P. Vorobev ◽  
A. G. Mrochek
Keyword(s):  
Risk Stratification ◽  
Qt Interval ◽  
Prognostic Significance ◽  
Ventricular Tachyarrhythmias ◽  
T Wave ◽  
Fragmented Qrs ◽  
Electrical Instability ◽  
Life Threatening ◽  
Rate Deceleration ◽  
The Individual

Aim. To develop and test a risk-stratification model for patients with coronary artery disease (CAD) and non-ischemic pathologies based on a computer analysis of electrical instability ECG markers.Material and methods. In the period from 2011 to 2018, the study included 1014 patients with CAD and non-ischemic pathologies. Depending on ventricular arrhythmia status, the analyzed cohort was divided into 3 groups: 1) 644 patients without lifethreatening ventricular tachyarrhythmias (-VTA), mean age 51,7±16,1 years; 2) 280 patients with clinically significant ventricular arrhythmias (+csVA): ventricular extrasystoles (VES) >1500/24 h, coupled VES >50/24 h or unstable ventricular tachycardia (uVT), mean age 46,7±14,0 years; 3) 90 patients with life-threatening ventricular tachyarrhythmias (+VTA): persistent VT (pVT), successful cardiopulmonary resuscitation (CPR), appropriate discharges by implanted cardioverter defibrillator (CVD), sudden cardiac death (SCD), mean age 46,8±12,7 years.Using the Intekard 7.3 software, ECG markers of myocardial electrical instability were analyzed: T wave alternation, QT interval and dispersion, fragmented QRS, spatial QRS-T angle, turbulence onset and slope, and heart rate deceleration/acceleration.Results. Statistically significant differences were found between the values of T wave alternation, QT interval, fragmented QRS and QRS-T angle in groups 1 and 3 (-VTA) and (+VTA), p<0,005.Personalized model was formed for predicting the risk of life-threatening VTA (primary endpoints: pVT, appropriate CVD discharges, CPR, SCD) in patients with CAD and non-ischemic pathologies (cardiomyopathy, channelopathy) in 5 years follow-up. Integral score of myocardial electrical instability is proposed as new quantitative parameter for risk stratification (sensitivity 75%, specificity 78%, accuracy 77%).Conclusion. The myocardial electrical instability score provides the individual assessment of the dynamic SCD risk. The Intekard 7.3 software is a simple, economic and accessible ECG tool for arrhythmia monitoring.

scholarly journals P1736Two-step risk stratification of life-threatening ventricular tachyarrhythmias in patients with dilated cardiomyopathy

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii377-iii378
Author(s):  
TG. Vaikhanskaya ◽  
VC. Barsukevich ◽  
OP. Melnikova ◽  
AV. Frolov
Keyword(s):  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Ventricular Tachyarrhythmias ◽  
Life Threatening

The Association between T-Wave Morphology and Life-Threatening Ventricular Tachyarrhythmias in Patients with Congestive Heart Failure

2009 ◽  
Vol 32 (9) ◽  
pp. 1173-1177 ◽  
Author(s):  
YEN-HUNG LIN ◽  
LIAN-YU LIN ◽  
YING-SHREN CHEN ◽  
HUI-CHUN HUANG ◽  
JEN-KUANG LEE ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Ventricular Tachyarrhythmias ◽  
T Wave ◽  
Wave Morphology ◽  
Life Threatening

Abstract 2148: Abnormal T Wave Alternans Could Provide Additional Risk Stratification in Patients with Prolonged QRS Duration

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Takanao Mine ◽  
Tetsuzou Kanemori ◽  
Hiroaki Nakamura ◽  
Tohru Masuyama ◽  
Mitsumasa Ohyanagi
Keyword(s):  
Heart Rate ◽  
Risk Stratification ◽  
Cardiac Death ◽  
Heart Diseases ◽  
Qt Dispersion ◽  
Additional Risk ◽  
T Wave ◽  
Life Threatening ◽  
Qrs Duration ◽  
T Wave Alternans

QT dispersion, signal averaged electrocardiogram (SAECG) and T wave alternans (TWA) have been found to be increased susceptibility to life-threatening arrhythmias or cardiac death (LTA/CD). Patients with heart diseases often present prolonged QRS duration (p-QRSd), however the risk stratification in patients with p-QRSd still remains. We investigated whether QT dispersion, SAECG and TWA would provide additional risk stratification in patients with p-QRSd. We studied 52 patients (47 males, mean age 66±9 yrs) with QRS duration ≥ 120ms (34 RBBB type and 18 LBBB type) who had heart diseases (45 coronary artery disease and 7 dilated cardiomyopaty). QT dispersion was measured from standard 12-lead ECG. The filtered QRS duration (f-QRS) and root mean square voltage of the terminal 40ms of the QRS complex (RMS40) were obtained by SAECG. TWA was measured with the CH 2000. TWA was considered positive when the alternans with alternans voltage ≥ 1.9μV and alternance ratio ≥ 3 was sustained ≥ 1 minute in vector magnitude, X, Y, Z, V4 or two precordal leads at heart rate ≤ 110bpm. TWA was classified negative when the alternans wasn’t presented at heart rate ≤ 110bpm and considered indeterminate if the record didn’t meet either positively or negatively. Abnormal TWA was defined as positive or indeterminate. An abnormal TWA test was present in 56% (23 patients had negative TWA, 11 had indeterminate and 18 had positive). During the follow-up periods (69±41 months), 15 patients had life-threatening arrhythmias (n=12) and/or cardiac death (n=7). Univariate analysis revealed left ventricular ejection fraction (LVEF), RMS40 and abnormal TWA (n=29) as significant variables, however there was no significant difference in LTA/CD rate between BBB types, and no associations between QT dispersion and LTA/CD. On logistic regression analysis, only LVEF (p=0.02) and abnormal TWA (p=0.02, odds ratio 9.803 [95%CI 1.430 to 67.207]) were independently associated with LTA/CD. Abnormal T wave alternans could provide additional risk stratification in patients with prolonged QRS duration.

Risk stratification personalised model for prediction of life-threatening ventricular tachyarrhythmias in patients with chronic heart failure

2017 ◽  
pp. 682-688 ◽  
Author(s):  
Alexander Vladimirovich Frolov ◽  
Tatjana Gennadjevna Vaikhanskaya ◽  
Olga Petrovna Melnikova ◽  
Anatoly Pavlovich Vorobiev ◽  
Ludmila Michajlovna Guel
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Risk Stratification ◽  
Ventricular Tachyarrhythmias ◽  
Life Threatening

T-wave alternans and dispersion of the QT interval as risk stratification markers in patients susceptible to sustained ventricular arrhythmias

1998 ◽  
Vol 82 (9) ◽  
pp. 1127-1129 ◽  
Author(s):  
Antonis A Armoundas ◽  
Motohisa Osaka ◽  
Theofanie Mela ◽  
David S Rosenbaum ◽  
Jeremy N Ruskin ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Qt Interval ◽  
Ventricular Arrhythmias ◽  
T Wave ◽  
T Wave Alternans

Risk Stratification for Ventricular Tachyarrhythmias by Ambulatory Electrocardiogram-Based Frequency Domain T-Wave Alternans

2015 ◽  
Vol 38 (12) ◽  
pp. 1425-1433 ◽  
Author(s):  
MASATO KAWASAKI ◽  
TAKAHISA YAMADA ◽  
TAKASHI MORITA ◽  
YOSHIO FURUKAWA ◽  
SHUNSUKE TAMAKI ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Frequency Domain ◽  
Ventricular Tachyarrhythmias ◽  
T Wave ◽  
T Wave Alternans

Effectiveness of T wave alternans testing for risk stratification of ventricular tachyarrhythmias and sudden death in patients with cardiomyopathy

2019 ◽  
Vol 57 ◽  
pp. S103
Author(s):  
Behnaz Ghoraani ◽  
Adrian M. Suszko ◽  
Raja J. Selvaraj ◽  
Anandaraja Subramanian ◽  
Sridhar Krishnan ◽  
...  
Keyword(s):  
Sudden Death ◽  
Risk Stratification ◽  
Ventricular Tachyarrhythmias ◽  
T Wave ◽  
T Wave Alternans
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