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Prolonged Tpeak-Tend interval is associated with ventricular fibrillation during reperfusion in ST-elevation myocardial infarction

Demidova, M. M. LU ; Carlson, J. LU ; Erlinge, D. LU ; Azarov, J. E. and Platonov, P. G. LU (2019) In International Journal of Cardiology
Abstract

Aim: Ventricular fibrillation (VF) during reperfusion in ST-elevation myocardial infarction (STEMI) is associated with increased in-hospital mortality. Dispersion of ventricular repolarization contributes to ventricular vulnerability during ischemia. Tpeak-Tend interval was proposed as a ventricular repolarization dispersion marker, however its value for prediction of reperfusion VF remains uncertain. We aimed to assess whether Tpeak-Tend before PCI in STEMI is associated with reperfusion VF. Methods: STEMI patients admitted for primary PCI were retrospectively assessed for VF during reperfusion. Pre-PCI ECGs recorded in 40 patients with reperfusion VF (rVF group; age 65 ± 13 years, 80% male)... (More)

Aim: Ventricular fibrillation (VF) during reperfusion in ST-elevation myocardial infarction (STEMI) is associated with increased in-hospital mortality. Dispersion of ventricular repolarization contributes to ventricular vulnerability during ischemia. Tpeak-Tend interval was proposed as a ventricular repolarization dispersion marker, however its value for prediction of reperfusion VF remains uncertain. We aimed to assess whether Tpeak-Tend before PCI in STEMI is associated with reperfusion VF. Methods: STEMI patients admitted for primary PCI were retrospectively assessed for VF during reperfusion. Pre-PCI ECGs recorded in 40 patients with reperfusion VF (rVF group; age 65 ± 13 years, 80% male) were compared with 374 consecutive patients without reperfusion arrhythmias (No-rVF group; age 67 ± 12 years; 68% male). Digital ECGs were automatically processed and Tpeak-Tend interval computed on a per-lead basis. The global Tpeak-Tend was calculated between the earliest Tpeak and the latest Tend in any lead, and tested for association with reperfusion VF using logistic regression analysis. Results: The leftward shift of Tpeak toward QRS complex in ischemic leads resulted in Tpeak-Tend prolongation. Global Tpeak-Tend in rVF group was higher than in No-rVF group (142 ± 24 vs 130 ± 27 ms; p = 0.007). Global Tpeak-Tend ≥ 131 ms predicted reperfusion VF (OR = 3.41; 95% CI 1.66–7.04; p = 0.001) and remained a significant predictor of reperfusion VF in multivariable analysis. Conclusion: Tpeak-Tend interval before PCI in STEMI was an independent predictor of reperfusion VF. Our findings warrants further research aimed at prospective validation of Tpeak-Tend as a marker of periprocedural arrhythmic risk.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Myocardial ischemia, ST-elevation myocardial infarction, TT, Ventricular fibrillation
in
International Journal of Cardiology
publisher
Elsevier
external identifiers
  • scopus:85060076230
ISSN
0167-5273
DOI
10.1016/j.ijcard.2019.01.008
language
English
LU publication?
yes
id
3f9f46c9-7091-4202-bc87-d0d6e8eb24c2
date added to LUP
2019-01-29 14:33:57
date last changed
2019-02-20 11:45:03
@article{3f9f46c9-7091-4202-bc87-d0d6e8eb24c2,
  abstract     = {<p>Aim: Ventricular fibrillation (VF) during reperfusion in ST-elevation myocardial infarction (STEMI) is associated with increased in-hospital mortality. Dispersion of ventricular repolarization contributes to ventricular vulnerability during ischemia. T<sub>peak</sub>-T<sub>end</sub> interval was proposed as a ventricular repolarization dispersion marker, however its value for prediction of reperfusion VF remains uncertain. We aimed to assess whether T<sub>peak</sub>-T<sub>end</sub> before PCI in STEMI is associated with reperfusion VF. Methods: STEMI patients admitted for primary PCI were retrospectively assessed for VF during reperfusion. Pre-PCI ECGs recorded in 40 patients with reperfusion VF (rVF group; age 65 ± 13 years, 80% male) were compared with 374 consecutive patients without reperfusion arrhythmias (No-rVF group; age 67 ± 12 years; 68% male). Digital ECGs were automatically processed and T<sub>peak</sub>-T<sub>end</sub> interval computed on a per-lead basis. The global T<sub>peak</sub>-T<sub>end</sub> was calculated between the earliest T<sub>peak</sub> and the latest T<sub>end</sub> in any lead, and tested for association with reperfusion VF using logistic regression analysis. Results: The leftward shift of T<sub>peak</sub> toward QRS complex in ischemic leads resulted in T<sub>peak</sub>-T<sub>end</sub> prolongation. Global T<sub>peak</sub>-T<sub>end</sub> in rVF group was higher than in No-rVF group (142 ± 24 vs 130 ± 27 ms; p = 0.007). Global T<sub>peak</sub>-T<sub>end</sub> ≥ 131 ms predicted reperfusion VF (OR = 3.41; 95% CI 1.66–7.04; p = 0.001) and remained a significant predictor of reperfusion VF in multivariable analysis. Conclusion: T<sub>peak</sub>-T<sub>end</sub> interval before PCI in STEMI was an independent predictor of reperfusion VF. Our findings warrants further research aimed at prospective validation of T<sub>peak</sub>-T<sub>end</sub> as a marker of periprocedural arrhythmic risk.</p>},
  author       = {Demidova, M. M. and Carlson, J. and Erlinge, D. and Azarov, J. E. and Platonov, P. G.},
  issn         = {0167-5273},
  keyword      = {Myocardial ischemia,ST-elevation myocardial infarction,TT,Ventricular fibrillation},
  language     = {eng},
  month        = {01},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {Prolonged T<sub>peak</sub>-T<sub>end</sub> interval is associated with ventricular fibrillation during reperfusion in ST-elevation myocardial infarction},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2019.01.008},
  year         = {2019},
}