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Keywords:

  • chronic heart failure;
  • QT variability;
  • heart rate variability;
  • autonomic nervous system;
  • sudden cardiac death

Background

The QT variability index, calculated between Q- and the T-wave end (QTendVI), is an index of temporal myocardial repolarization lability associated with sudden cardiac death (SCD) in chronic heart failure (CHF). Little is known about temporal variability in the other two temporal myocardial repolarization descriptors obtained from Q–Tpeak and Tpeak–Tend intervals. We therefore investigated differences between these indexes in patients with CHF who died suddenly and in those who survived with a left ventricular ejection fraction (LVEF) ≤35% or >35%.

Methods and Results

We selected 127 ECG and systolic blood pressure (SPB) recordings from outpatients with CHF all of whom had been followed up for 30 months. We calculated RR and SPB variability by power spectral analysis and QTendVI, QTpeakVI, TpeakTendVI. We then subdivided data patients into three groups SCD, LVEF ≤ 35%, and LVEF > 35%. The LVEF was higher in the SCD than in the LVEF ≤ 35% group, whereas no difference was found between the SCD and LVEF > 35% groups. QTendVI, QTpeakVI, and TpeakTendVI were higher in the SCD and LVEF ≤ 35% groups than in the LVEF > 35% group. Multivariate analysis detected a negative relationship between all repolarization variability indexes, low frequency obtained from RR intervals and LVEF.

Conclusions

Our data show that variability in the first (QTpeakVI) and second halves of the QT interval (Tpeak–TendVI) significantly contributes to the QTendVI in patients with CHF. Further studies should investigate whether these indexes might help stratify the risk of SCD in patients with a moderately depressed LVEF.