Comparison of QT interval variability of coronary patients without myocardial infarction with that of patients with old myocardial infarction

BACKGROUND The significant association of myocardial ischemia with elevated QT interval variability (QTV) has been reported in myocardial infarction (MI) patients. However, the influence of the time course of MI on QTV has not been investigated systematically. METHOD Short-term QT and RR interval time series were constructed from the 5 min electrocardiograms of 49 coronary patients without MI and 26 patients with old MI (OMI). The QTV, heart rate variability (HRV), and QT-RR coupling of the two groups were analyzed using various time series analysis tools in the time- and frequency-domains, as well as nonlinear dynamics. RESULTS Nearly all of the tested QTV indices for coronary patients with OMI were higher than those for patients without MI. However, no significant differences were found between the two groups in any of the variables employed to assess the HRV and QT-RR coupling. All of the markers that showed statistical significances in univariate analyses still possessed the capabilities of distinguishing between the two groups even after adjusting for studied baseline characteristics, including the coronary atherosclerotic burden. CONCLUSIONS The results suggested that the QTV increased in coronary patients with OMI compared to those without MI, which might reflect the influence of post-MI remodeling on the beat-to-beat temporal variability of ventricular repolarization. The non-significant differences in the HRV and QT-RR couplings could indicate that there were no differences in the modulation of the autonomic nervous system and interaction of QT with the RR intervals between the two groups.

[1]  Mathias Baumert,et al.  Relation between QT interval variability and cardiac sympathetic innervation in patients with diabetes mellitus , 2011, 2011 Computing in Cardiology.

[2]  B. Fetics,et al.  Short-term variability of repolarization predicts ventricular tachycardia and sudden cardiac death in patients with structural heart disease: a comparison with QT variability index. , 2011, Heart rhythm.

[3]  Xiao Hu,et al.  Automatic detection of onset and offset of QRS complexes independent of isoelectric segments , 2014 .

[4]  N. Sharpe,et al.  Left ventricular remodeling after myocardial infarction: pathophysiology and therapy. , 2000, Circulation.

[5]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[6]  V. Starc,et al.  Beat-to-beat QT interval variability in coronary patients. , 2000, Journal of electrocardiology.

[7]  B. Stricker,et al.  Short-term QT variability markers for the prediction of ventricular arrhythmias and sudden cardiac death: a systematic review , 2014, Heart.

[8]  Nathaniel H. Hunt,et al.  The Appropriate Use of Approximate Entropy and Sample Entropy with Short Data Sets , 2012, Annals of Biomedical Engineering.

[9]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[10]  W.J. Tompkins,et al.  ECG beat detection using filter banks , 1999, IEEE Transactions on Biomedical Engineering.

[11]  Alberto Porta,et al.  Frequency domain assessment of the coupling strength between ventricular repolarization duration and heart period during graded head-up tilt , 2011, Journal of electrocardiology.

[12]  Pedro D Arini,et al.  Beat-to-beat electrocardiographic analysis of ventricular repolarization variability in patients after myocardial infarction. , 2016, Journal of electrocardiology.

[13]  Piet Claus,et al.  Microvolt T-wave alternans and beat-to-beat variability of repolarization during early postischemic remodeling in a pig heart. , 2011, Heart rhythm.

[14]  Mika P. Tarvainen,et al.  An advanced detrending method with application to HRV analysis , 2002, IEEE Transactions on Biomedical Engineering.

[15]  Carmen Vidaurre,et al.  BioSig: The Free and Open Source Software Library for Biomedical Signal Processing , 2011, Comput. Intell. Neurosci..

[16]  S. Hohnloser,et al.  Assessment of QT dispersion for prediction of mortality or arrhythmic events after myocardial infarction: results of a prospective, long-term follow-up study. , 1998, Circulation.

[17]  A. Kadish,et al.  Dissociation of heart rate variability from parasympathetic tone. , 1994, The American journal of physiology.

[18]  Qinghua Zhang,et al.  An Algorithm for Robust and Efficient Location of T-Wave Ends in Electrocardiograms , 2006, IEEE Transactions on Biomedical Engineering.

[19]  A. Malliani,et al.  Quantifying electrocardiogram RT-RR variability interactions , 2006, Medical and Biological Engineering and Computing.

[20]  J. Richman,et al.  Physiological time-series analysis using approximate entropy and sample entropy. , 2000, American journal of physiology. Heart and circulatory physiology.

[21]  Vito Starc,et al.  Coronary Artery Disease Alters Ventricular Repolarization Dynamics in Type 2 Diabetes , 2005, Pacing and clinical electrophysiology : PACE.

[22]  D. Kass,et al.  Beat-to-beat QT interval variability associated with acute myocardial ischemia. , 2002, Journal of electrocardiology.

[23]  Dingchang Zheng,et al.  Detection of Coupling in Short Physiological Series by a Joint Distribution Entropy Method , 2016, IEEE Transactions on Biomedical Engineering.

[24]  J. C. Ogilvie,et al.  Measuring baseline-treatment differences in heart rate variability: variance versus successive difference mean square and beats per minute versus interbeat intervals. , 1979, Psychophysiology.

[25]  Robert S Sheldon,et al.  Noninvasive risk assessment early after a myocardial infarction the REFINE study. , 2007, Journal of the American College of Cardiology.

[26]  R. Quaglione,et al.  Influence of aging and chronic heart failure on temporal dispersion of myocardial repolarization , 2013, Clinical interventions in aging.

[27]  L. Kuller,et al.  Natural History of Ischemic Heart Disease in Relation to Arteriographic Findings: A Twelve Year Study of 224 Patients , 1974, Circulation.

[28]  Teng Wang,et al.  Differences in the changing trends of monophasic action potential duration and effective refractory period of the ventricular myocardium after myocardial infarction in vivo. , 2004, Circulation journal : official journal of the Japanese Circulation Society.

[29]  H. Wichmann,et al.  Usefulness of short-term variability of QT intervals as a predictor for electrical remodeling and proarrhythmia in patients with nonischemic heart failure. , 2010, The American journal of cardiology.

[30]  Patrícia Chagas,et al.  Egg consumption and coronary atherosclerotic burden. , 2013, Atherosclerosis.

[31]  Koushik Maharatna,et al.  An automated algorithm for online detection of fragmented QRS and identification of its various morphologies , 2013, Journal of The Royal Society Interface.

[32]  Larisa G. Tereshchenko,et al.  Correlation between the high-frequency content of the QRS on murine surface electrocardiogram and the sympathetic nerves density in left ventricle after myocardial infarction: Experimental study. , 2017, Journal of electrocardiology.

[33]  György Ábrahám,et al.  Increased Short-Term Beat-to-Beat QT Interval Variability in Patients with Impaired Glucose Tolerance , 2017, Front. Endocrinol..

[34]  R. Berger.  QT interval variability is it a measure of autonomic activity? , 2009, Journal of the American College of Cardiology.

[35]  Marimuthu Palaniswami,et al.  Stability, Consistency and Performance of Distribution Entropy in Analysing Short Length Heart Rate Variability (HRV) Signal , 2017, Front. Physiol..

[36]  M. Haigney,et al.  QT Variability Index. , 2013, Progress in cardiovascular diseases.

[37]  Esben Vedel-Larsen,et al.  The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. , 2009, Journal of electrocardiology.

[38]  Peter Gaudron,et al.  Progressive Left Ventricular Dysfunction and Remodeling After Myocardial Infarction Potential Mechanisms and Early Predictors , 1993, Circulation.

[39]  Ronald W. Schafer,et al.  What Is a Savitzky-Golay Filter? [Lecture Notes] , 2011, IEEE Signal Processing Magazine.

[40]  A. Porta,et al.  RT variability unrelated to heart period and respiration progressively increases during graded head-up tilt. , 2010, American journal of physiology. Heart and circulatory physiology.

[41]  Samir Saba,et al.  Recent heart rate history affects QT interval duration in atrial fibrillation , 2017, PloS one.

[42]  S. Johansson,et al.  Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review , 2017, BMC Cardiovascular Disorders.

[43]  JS Sorensen,et al.  A comparison of IIR and wavelet filtering for noise reduction of the ECG , 2010, 2010 Computing in Cardiology.

[44]  E. W. Hancock,et al.  AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American , 2009, Journal of the American College of Cardiology.

[45]  M Baumert,et al.  Beat-to-beat QT interval variability and T-wave amplitude in patients with myocardial infarction , 2013, Physiological measurement.

[46]  Godfrey L. Smith,et al.  QT interval variability in body surface ECG: measurement, physiological basis, and clinical value: position statement and consensus guidance endorsed by the European Heart Rhythm Association jointly with the ESC Working Group on Cardiac Cellular Electrophysiology. , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[47]  Mathias Baumert,et al.  Relation between QT interval variability and cardiac sympathetic activity in hypertension. , 2011, American journal of physiology. Heart and circulatory physiology.

[48]  M. Pfeffer,et al.  Ventricular Remodeling After Myocardial Infarction: Experimental Observations and Clinical Implications , 1990, Circulation.

[49]  H. Calkins,et al.  Beat-to-beat QT interval variability: novel evidence for repolarization lability in ischemic and nonischemic dilated cardiomyopathy. , 1997, Circulation.

[50]  Andreas Holzinger,et al.  Selection of entropy-measure parameters for knowledge discovery in heart rate variability data , 2014, BMC Bioinformatics.

[51]  H. Katus,et al.  Course and prognostic implications of QT interval and QT interval variability after primary coronary angioplasty in acute myocardial infarction. , 2001, Journal of the American College of Cardiology.

[52]  Lemuel A Moyé,et al.  Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction. , 2002, Journal of the American College of Cardiology.

[53]  Jiapu Pan,et al.  The Relationship between Ventricular Repolarization Duration and RR Interval in Normal Subjects and Patients with Myocardial Infarction , 2008, Cardiology.

[54]  Wei Sun,et al.  Mechanisms Contributing to the Progression of Ischemic and Nonischemic Dilated Cardiomyopathy: Possible Modulating Effects of Paracrine Activities of Stem Cells. , 2015, Journal of the American College of Cardiology.

[55]  Mathias Baumert,et al.  Conventional QT Variability Measurement vs. Template Matching Techniques: Comparison of Performance Using Simulated and Real ECG , 2012, PloS one.

[56]  Dingchang Zheng,et al.  Assessing the complexity of short-term heartbeat interval series by distribution entropy , 2014, Medical & Biological Engineering & Computing.

[57]  Esa Räsänen,et al.  Information transfer in QT-RR dynamics: Application to QT-correction , 2018, Scientific Reports.

[58]  D Qin,et al.  Cellular and ionic basis of arrhythmias in postinfarction remodeled ventricular myocardium. , 1996, Circulation research.

[59]  Antonello Maruotti,et al.  Autonomic nerve activity and the short-term variability of the Tpeak-Tend interval in dogs with pacing-induced heart failure. , 2012, Heart rhythm.