Quantitative T-wave Analysis Predicts 1 Year Prognosis In 447 Cases With Chronic Heart Failure

Background and Aims:T-wave abnormality is common electrocardiographic occurrences in patients with chronic heart failure (CHF). It is Often considered to be meaningful in clinic emergence such as acute myocardial infarction, especially in super-acute stage, and physician use them to guide diagnosis and therapies. These abnormalities are considered to be relatively benign and when a patient's situation is relatively stable and its prognostic value is not fully-estimated. Recently, Michael D Jacobsen and other authors designed a setting of ways by which T-wave abnormality in ECG is quantitatively analyzed. The T-wave abnormalities criterion was based on a new set of normal T-wave amplitude normal T-wave limits differentiated by gender, age, electrocardiographic leads, and QRS axis. And different categories of T-wave abnormalities was tested as dependent predictors in cases with Non-ST-Segment Elevation Acute Coronary Syndromes, and results showed T-wave abnormalities is in relation to adverse outcome. In another study, nine categories of T-wave abnormalities were tested in the FRISCⅡstudy population, tying to prove that the quantitative T-wave analysis predicts lyear prognosis and benefit from early invasive treatment. The results proved five of nine categories were significant associated with an adverse outcome. They drew conclusions that new quantitative T-waves analysis of the admission ECG gives additional predictive information concerning clinical outcomes and identifies patients who benefit from early coronary angiography. Under such circumstances, the objective of present study is to examine the prognostic information of the new quantitative T-waves abnormalities analysis as predictors in patients with CHF. As it was showed, the way is so difficult in both identifying if a T-wave is normal and calculating the abnormal amplitudes compared with the norm that we need taking great effort to be held and used. So in present study, a newer corrected quantitative way is used.MethodsStudy Population: The patients in this study were enrolled in all the patients in hospitalization in Nan-Fang hospital since January 2000 to August 2005 diagnosised CHF due to all kinds of reasons. All the admission cases were reviewed and the diagnosis was accordance with the norm of The Guideline of ESC 2005 Adult Chronic Heart Failure. The admission patients were treated after the first admission of the Hospitalization by standard therapies, and attended the out-patient department regularly within 1 year; the heart activities recovery at least to NYHA(New York Heart activity Grades) Grade 3, the heart activities were evaluated to be in stage C according the new 2005 ACC/ AHA norm.Exclusion criterion: The main exclusion criteria were increased risk of hemorrhage, indication for thrombolytic therapy, ongoing serious arrhythmia, and serious diseases such as malignant tumor, liver dysfunction, serious kidney dysfunction which would influence patients' life expectation; CHF due to other systemic serious diseases such as the hyperthyroidism that were not completely controlled.ECG Study exclusion criteria were heart rate＞110 beats/min, atrial flutter, and conditions producing secondary T-wave abnormalities such as bundle block, ventricular pacing, ventricular rhythm ventricular preexcitation, or left ventricular hypertrophy(because the high-voltage depolarization in left ventricular could cause secondary repolarization changes). The remaining 447 patients were included in this study and the admission date was the day allowed to Out-hospitalization. The admission ECG was the last one before leaving the hospital. Follow-up period was defined from 30 days after the ECG was taken to lyear.ECG analysis: The admission ECGs were analyzed at ECG Room of the Cardiovascular Department in the Nan-Fang Hospital by the professional senior ECG technician. Independently, Criteria for T-wave abnormality in a certain lead is based on the data base applying for 95% normal people data in the book written by Zhengwu Xie. Based on the ways of Michael D Jacobsen, seven T-wave abnormalities categories was tested in the present study. These are based on ECG groups, the number of leads with abnormal T-wave. Compared with the previous ways, the summation of T-wave amplitude abnormalities was given up because of its complexities in practice.Study endpointsThe study endpoint was a composite of death or a outbreak of Acute heart failure (AHF) or the heart activity steps into stage D although after the Best therapy of CHF within the period (From 30 days to 1 year after admission date). AHF was defined by the 2005 Guideline of CHF of ACC/ AHA and by the Clinic Serious DegreeⅣ(wet and cold).All cases of the study endpoints were adjudicated by all members of the research group.Statistical methodsCategorical data are presented by number (%). Continuous variables are presented as medians ( interquartile range).All analysis were performed using the SPSS version 13.0. Comparisons of categorical characteristic were commited to Binary Logistic regression. The presence of one category (i.e. T-wave abnormality in≥6) was analyzed for its predictive value.Binary logistic regression was used for multivariable analysis, which were applied to examine the association between T-wave abnormalities categories as well as some kind of baseline characteristics and endpoint events, apply binary logistic regression,ResultBaseline characteristics and patient outcomesA total 447 patents was included the present study. The baseline characteristics presented in table 1. Patients with≥6 leads abnormal T-wave in all leads (OR=2.197; P=0.015) andpatient with≥2 consecutive leads in V4-6 (OR=2.240; P=0.010) have a high risk occurrence of endpoint events, and double ventricular heart failure when admission of hospitalization (OR=4.658; P=0.011) and initial acute heart failure(AHF;NYHA 4 degree; OR=1.612; P=0.019) have the higher risk, meanwhile the admission Beta-block (OR=0.458; P=0.013) has lower endpoint occurrence.Conclusion New quantitative T-wave analysis of the admission ECG of CHF was proved to be useful in predicting the prognosis of 1 year in patents, and the further the ECG T-wave abnormalities of a patient, the higher the risk of adverse outcome. And the way can be used to be predictor of early risk stratification and supply information for the physician.