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Palacios S, Cygankiewicz I, Bayés de Luna A, Pueyo E, Martínez JP. Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients. Sci Rep 2021; 11:20546. [PMID: 34654872 PMCID: PMC8519935 DOI: 10.1038/s41598-021-99861-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022] Open
Abstract
The two most common modes of death among chronic heart failure (CHF) patients are sudden cardiac death (SCD) and pump failure death (PFD). Periodic repolarization dynamics (PRD) quantifies low-frequency oscillations in the T wave vector of the electrocardiogram (ECG) and has been postulated to reflect sympathetic modulation of ventricular repolarization. This study aims to evaluate the prognostic value of PRD to predict SCD and PFD in a population of CHF patients. 20-min high-resolution (1000 Hz) ECG recordings from 569 CHF patients were analyzed. Patients were divided into two groups, \documentclass[12pt]{minimal}
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\begin{document}$$\hbox {PRD}^+$$\end{document}PRD+ and \documentclass[12pt]{minimal}
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\begin{document}$$\hbox {PRD}^-$$\end{document}PRD-, corresponding to PRD values above and below the optimum cutoff point of PRD in the study population. Univariate Cox regression analysis showed that SCD risk in the \documentclass[12pt]{minimal}
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\begin{document}$$\hbox {PRD}^+$$\end{document}PRD+ group was double the risk in the \documentclass[12pt]{minimal}
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\begin{document}$$\hbox {PRD}^-$$\end{document}PRD- group [hazard ratio (95% CI) 2.001 (1.127–3.554), \documentclass[12pt]{minimal}
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\begin{document}$$\hbox {p}<0.05$$\end{document}p<0.05]. The combination of PRD with other Holter-based ECG indices, such as turbulence slope (TS) and index of average alternans (IAA), improved SCD prediction by identifying groups of patients at high SCD risk. PFD could be predicted by PRD only when combined with TS [hazard ratio 2.758 (1.572–4.838), \documentclass[12pt]{minimal}
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\begin{document}$$\hbox {p}<0.001$$\end{document}p<0.001]. In conclusion, the combination of PRD with IAA and TS can be used to stratify the risk for SCD and PFD, respectively, in CHF patients.
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Affiliation(s)
- Saúl Palacios
- BSICoS Group, Aragón Institute of Engineering Research, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Antoni Bayés de Luna
- Cardiovascular Research Foundation, Cardiovascular ICCC-Program, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Esther Pueyo
- BSICoS Group, Aragón Institute of Engineering Research, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
| | - Juan Pablo Martínez
- BSICoS Group, Aragón Institute of Engineering Research, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.,CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza, Spain
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Hernández-Vicente A, Hernando D, Vicente-Rodríguez G, Bailón R, Garatachea N, Pueyo E. ECG Ventricular Repolarization Dynamics during Exercise: Temporal Profile, Relation to Heart Rate Variability and Effects of Age and Physical Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9497. [PMID: 34574421 PMCID: PMC8469015 DOI: 10.3390/ijerph18189497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 12/18/2022]
Abstract
Periodic repolarization dynamics (PRD) is a novel electrocardiographic marker of cardiac repolarization instability with powerful risk stratification capacity for total mortality and sudden cardiac death. Here, we use a time-frequency analysis approach to continuously quantify PRD at rest and during exercise, assess its dependence on heart rate variability (HRV) and characterize the effects of age (young adults/middle-aged adults/older adults), body mass index (non-overweight/overweight) and cardiorespiratory fitness level (fit/unfit). Sixty-six male volunteers performed an exercise test. RR and dT variabilities (RRV, dTV), as well as the fraction of dT variability unrelated to RR variability, were computed based on time-frequency representations. The instantaneous LF power of dT (PdTV), representing the same concept as PRD, and of its RRV-unrelated component (PdTVuRRV) were quantified. dT angle was found to mostly oscillate in the LF band. Overall, 50-70% of PdTV was linearly unrelated to RRV. The onset of exercise caused a sudden increase in PdTV and PdTVuRRV, which returned to pre-exercise levels during recovery. Clustering analysis identified a group of overweight and unfit individuals with significantly higher PdTV and PdTVuRRV values at rest than the rest of the population. Our findings shed new light on the temporal profile of PRD during exercise, its relationship to HRV and the differences in PRD between subjects according to phenotypic characteristics.
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Affiliation(s)
- Adrián Hernández-Vicente
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; (G.V.-R.); (N.G.)
- Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, 22002 Huesca, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), 50009 Zaragoza, Spain
| | - David Hernando
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain; (D.H.); (R.B.); (E.P.)
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Germán Vicente-Rodríguez
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; (G.V.-R.); (N.G.)
- Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, 22002 Huesca, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBER-Obn), 28029 Madrid, Spain
- Instituto Agroalimentario de Aragón -IA2- CITA-Universidad de Zaragoza, 50013 Zaragoza, Spain
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain; (D.H.); (R.B.); (E.P.)
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Nuria Garatachea
- Growth, Exercise, NUtrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain; (G.V.-R.); (N.G.)
- Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, 22002 Huesca, Spain
- Red española de Investigación en Ejercicio Físico y Salud en Poblaciones Especiales (EXERNET), 50009 Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBER-Obn), 28029 Madrid, Spain
- Instituto Agroalimentario de Aragón -IA2- CITA-Universidad de Zaragoza, 50013 Zaragoza, Spain
| | - Esther Pueyo
- Biomedical Signal Interpretation and Computational Simulation (BSICoS), Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, 50018 Zaragoza, Spain; (D.H.); (R.B.); (E.P.)
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
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Schüttler D, Krammer S, von Stülpnagel L, Sams L, Bauer A, Hamm W, Brunner S. Estimation of anaerobic threshold by cardiac repolarization instability: a prospective validation study. BMC Sports Sci Med Rehabil 2021; 13:85. [PMID: 34362449 PMCID: PMC8344172 DOI: 10.1186/s13102-021-00312-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 07/07/2021] [Indexed: 11/18/2022]
Abstract
Background Assessing lactate (LT) or anaerobic thresholds (AT) in athletes is an important tool to control training intensities and to estimate individual performance levels. Previously we demonstrated that ECG-based assessment of cardiac repolarization instability during exercise testing allows non-invasive estimation of AT in recreational athletes. Here, we validate this method in professional and amateur team sports athletes. Methods We included 65 team sports athletes (32 professionals and 33 amateur athletes; 51 men, 14 women, mean age 22.3 ± 5.2 years) undergoing a standardized incremental cycle exercise test. During exercise testing a high-resolution ECG (1000 Hz) was recorded in Frank-leads configuration and beat-to-beat vector changes of cardiac repolarization (dT°) were assessed by previously established technologies. Repolarization-based AT (ATdT°) was estimated by its typical dT°-signal pattern. Additionally, LT was detected in accordance to methods established by Mader (LTMader) and Dickhuth (LTDickhuth). Results All athletes performed exercise testing until exhaustion with a mean maximum workload of 262.3 ± 60.8 W (241.8 ± 64.4 W for amateur athletes and 283.4 ± 49.5 W for professional athletes). Athletes showed ATdT° at 187.6 ± 44.4 W, LTDickhuth at 181.1 ± 45.6 W and LTMader at 184.3 ± 52.4 W. ATdT° correlated highly significantly with LTDickhuth (r = 0.96, p < 0.001) and LTMader (r = 0.98, p < 0.001) in the entire cohort of athletes as well as in the subgroups of professional and amateur athletes (p < 0.001 for all). Conclusions ATdT°, defined by the maximal discordance between dT° and heart rate, can be assessed reliably and non-invasively via the use of a high-resolution ECG in professional and amateur athletes.
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Affiliation(s)
- Dominik Schüttler
- Department of Medicine I, University Hospital Munich, Campus Grosshadern and Innenstadt, Ludwig-Maximilians University Munich (LMU), Ziemssenstrasse 1, 80336, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance (MHA), Munich, Germany.,Ludwig-Maximilians University Munich (LMU), Walter Brendel Centre of Experimental Medicine, Munich, Germany
| | - Simone Krammer
- Department of Medicine I, University Hospital Munich, Campus Grosshadern and Innenstadt, Ludwig-Maximilians University Munich (LMU), Ziemssenstrasse 1, 80336, Munich, Germany
| | - Lukas von Stülpnagel
- Department of Medicine I, University Hospital Munich, Campus Grosshadern and Innenstadt, Ludwig-Maximilians University Munich (LMU), Ziemssenstrasse 1, 80336, Munich, Germany.,Medical University Innsbruck, University Hospital for Internal Medicine III, Innsbruck, Austria
| | - Lauren Sams
- Department of Medicine I, University Hospital Munich, Campus Grosshadern and Innenstadt, Ludwig-Maximilians University Munich (LMU), Ziemssenstrasse 1, 80336, Munich, Germany
| | - Axel Bauer
- Department of Medicine I, University Hospital Munich, Campus Grosshadern and Innenstadt, Ludwig-Maximilians University Munich (LMU), Ziemssenstrasse 1, 80336, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance (MHA), Munich, Germany.,Medical University Innsbruck, University Hospital for Internal Medicine III, Innsbruck, Austria
| | - Wolfgang Hamm
- Department of Medicine I, University Hospital Munich, Campus Grosshadern and Innenstadt, Ludwig-Maximilians University Munich (LMU), Ziemssenstrasse 1, 80336, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance (MHA), Munich, Germany
| | - Stefan Brunner
- Department of Medicine I, University Hospital Munich, Campus Grosshadern and Innenstadt, Ludwig-Maximilians University Munich (LMU), Ziemssenstrasse 1, 80336, Munich, Germany.
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