Impact of left ventricular remodeling on ventricular repolarization and heart rate variability in patients after myocardial infarction treated with primary PCI: prospective 6 months follow-up.
BACKGROUND
The relation between postinfarction left ventricle remodeling (LVR), autonomic nervous system and repolarization process is unclear. Purpose of the study was to assess the influence of LVR on the early (QTpeak) and late (TpeakTend) repolarization periods in patients after myocardial infarction (MI) treated with primary PCI. The day-to-night differences of repolarization parameters and the relation between QT and heart rate variability (HRV) indices, as well left ventricle function were also assessed.


METHODS
The study cohort of 104 pts was examined 6 months after acute MI. HRV and QT indices (corrected to the heart rate) were obtained from the entire 24-hour Holter recording, daytime and nighttime periods.


RESULTS
LVR was found in 33 patients (31.7%). The study groups (LVR+ vs LVR-) did not differ in age, the extent of coronary artery lesions and treatment. Left ventricle ejection fraction (LVEF) was lower (38%+/- 11% vs 55%+/- 11%, P < 0.001), both QTc (443 +/- 26 ms vs 420 +/- 20 ms, P < 0.001) and TpeakTendc (98 +/- 11 ms vs 84 +/- 12 ms, P < 0.005) were longer in LVR + patients, with no differences for QTpeakc. Trends toward lower values of time-domain (SDRR, rMSSD) HRV parameters were found in LVR+ pts. Day-to-night difference was observed only for SDRR, more marked in LVR-group. Remarkable relations between delta LVEF (6 months minus baseline), delta LVEDV and TpeakTendc were found, with no such relationships for QTpeakc.


CONCLUSIONS
The patients with LVR have longer repolarization time, especially the late phase-TpeakTend, which represents transmural dispersion of repolarization. Its prolongation seems to be related to local attributes of myocardium and global function of the left ventricle but unrelated to the autonomic nervous influences. Remodeling with moderate LV systolic dysfunction is associated with insignificant decrease in HRV indices and preserved circadian variability.
Szydlo
Krzysztof
K
I Department of Cardiology, Silesian Medical University, Katowice, Poland. krzysztofszydlo@onet.eu
Wita
Krystian
K
Trusz-Gluza
Maria
M
Urbanczyk
Dagmara
D
Filipecki
Artur
A
Orszulak
Witold
W
Tabor
Zbigniew
Z
Krauze
Jolanta
J
Kwasniewski
Wojciech
W
Myszor
Jaroslaw
J
Turski
Maciej
M
Kolasa
Jaroslaw
J
Szczogiel
Jan
J
D015906:Angioplasty, Balloon, Coronary; D001341:Autonomic Nervous System / Q000503:physiopathology; D002940:Circadian Rhythm; D015331:Cohort Studies; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling