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CLINICAL RESEARCH: HEART RHYTHM DISORDERS

Ventricular Repolarization Dynamicity Provides Independent Prognostic Information Toward Major Arrhythmic Events in Patients With Idiopathic Dilated Cardiomyopathy

Massimo Iacoviello, MD, PhD^_*,_*, Cinzia Forleo, MD, PhD^_*, Pietro Guida, PhD^_*, Roberta Romito, MD, Antonio Sorgente, MD^_*, Sandro Sorrentino, PhD^_*, Silvana Catucci, MD^_*, Filippo Mastropasqua, MD and Mariavittoria Pitzalis, MD, PhD

^_* Institute of Cardiology, University of Bari, Bari, Italy
Emergency Cardiology Department, University-Hospital of Bari, Bari, Italy
Division of Cardiology, "S. Maugeri" Foundation, Cassano delle Murge, Italy
Division of Cardiology, Department of Internal Medicine, The Brody School of Medicine at East Carolina University, Greenville, North Carolina

Manuscript received December 1, 2006; revised manuscript received February 6, 2007, accepted February 12, 2007.

^_* Reprint requests and correspondence: Dr. Massimo Iacoviello, Institute of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy. (Email: massimo.iacoviello{at}cardio.uniba.it).

Objectives: The purpose of this work was to evaluate whether ventricular repolarization dynamicity predicts major arrhythmic events in patients with idiopathic dilated cardiomyopathy (DCM).

Background: Arrhythmic risk stratification in patients with DCM is still an open issue. Ventricular repolarization analysis should provide relevant information, but QT interval and QT dispersion failed in predicting arrhythmic risk.

Methods: The following parameters were evaluated in 179 consecutive DCM patients without history of sustained ventricular tachycardia (VT) and/or ventricular fibrillation (VF) at enrollment: QRS duration, QT interval corrected for heart rate, and QT dispersion at electrocardiogram (ECG); left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter at echocardiogram; and nonsustained ventricular tachycardia (NSVT), heart rate variability (standard deviation of RR intervals), and ventricular repolarization dynamicity as measured by means of 24-h ECG monitoring, by calculating the slope of linear regression analysis of QT end and RR intervals (QTe-slope) and the value of mean QT end corrected for heart rate.

Results: During a mean follow-up of 39 months, 9 patients died suddenly and 15 experienced VT and/or VF. At multivariate analysis, LVEF (p = 0.047), NSVT (p = 0.022), and QTe-slope (p = 0.034) were significantly associated with arrhythmic events. Among the patients with a low LVEF, NSVT and/or steeper QTe-slope identified a subgroup at highest arrhythmic risk.

Conclusions: In patients with DCM, QT dynamicity is independently associated with the occurrence of major arrhythmic events and improves the predictive accuracy of stratifying arrhythmic risk of these patients.

Abbreviations and Acronyms   DCM = dilated cardiomyopathy   ICD = implantable cardioverter-defibrillator   LVEDD = left ventricular end-diastolic diameter   LVEF = left ventricular ejection fraction   NSVT = nonsustained ventricular tachycardia   QTa = QT apex   QTd = QT dispersion   QTe = QT end   QTe-slope = slope of linear regression analysis of QT end and RR intervals   SDNN = standard deviation of normal RR intervals   VF = ventricular fibrillation   VT = ventricular tachycardia

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