Hospital mortality in decompensated heart failure. A pilot study
Introduction
Decompensated chronic heart failure (CHF) is one the most common cause of hospitalization and mortality in western countries [1]. A number of possible biomarkers have been proposed and adopted in clinical practice to detect and to monitor CHF patients but, besides their elevated costs, they need the presence of the patient in a specialized clinical setting to be determined. Thus, it remains highly desirable to find out an accurate marker, possibly non-invasive, at low cost and easily repeatable, able to detect and monitor this widely-spread clinical syndrome. In such a context, heart rate (HRV) and QT variability (QTV) were studied in CHF in the nineties and, notwithstanding promising results, they have never been considered in the evidence-based clinical practice [2,3].
There are many clinical contexts in which ventricular repolarization, and in particular the QT dispersion parameters, in order to stratify the arrhythmic risk of patients affected by cardiovascular disease [4].
Among the most interesting ventricular repolarization markers, we can find the interval between the peak and the end of the T wave (Tpeak - Tend) which has been evaluated in different clinical contexts [5].
Therefore, the present pilot study sought to investigate a possible capability of the main short period markers of myocardial repolarization dispersion to detect those decompensated CHF patients at high mortality risk. Considering the high prevalence of atrial fibrillation as well as premature contraction or pacemaker-guided rhythm in this setting of patients, we focused our analysis on the electrocardiographic markers which do not depend on RR variance or sinus rhythm. Moreover, the speculation on these electrocardiographic markers in an elderly population is also lacking, despite CHF old patients represent the largest share of patients to be monitored and treated.
Section snippets
Patients and protocol
For this pilot study, we enrolled 101 consecutive patients admitted to our department, from January to December 2019, due to decompensated CHF. We defined patient with decompensated CHF as patient with at least one symptom/sign compatible with a decompensation and a previous documented history of CHF. At the hospitalization all patients underwent: clinical history, physical examination, standard electrocardiogram (ECG) and transthoracic echocardiography, 5 min of II lead ECG (MiocardioEvent™,
Results
Starting from 104 eligible patients, 3 patients were excluded because of the repolarization signals were suboptimal for the analysis. A total of 25 patients died during the hospitalization (overall mortality rate 25%): fifteen patients died for respiratory failure, six for terminal heart failure, two for fatal acute myocardial infarction, one for arrhythmic sudden cardiac death (sustained ventricular tachycardia and ventricular fibrillation). At the time of presentation, all patients were in
Discussion
The major finding of the present pilot study was that a simple, almost inexpensive and transmissible ECG signal was able to individuate decompensated CHF patients at high risk of in-hospital mortality. Indeed, the multivariable logistic regression showed high level of Te mean as the most accurate myocardial repolarization marker associated with high risk of in-hospital mortality in our sample. Thus, not the absolute value of Te but its short period temporal dispersion, in terms of standard
Financial disclosures
None.
CRediT authorship contribution statement
Gianfranco Piccirillo:Conceptualization, Data curation, Formal analysis, Project administration, Writing - original draft.Federica Moscucci:Methodology, Data curation, Writing - original draft, Validation.Marco Valerio Mariani:Investigation, Validation.Claudia Di Iorio:Investigation, Validation.Marcella Fabietti:Investigation, Validation.Fabiola Mastropietri:Investigation, Validation.Davide Crapanzano:Investigation, Validation.Gaetano Bertani:Investigation, Validation.Teresa Sabatino:
Declaration of competing interest
Every author denies personal or financial conflict of interest regarding this paper.
Acknowledgements
None.
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