Cargando…

Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction

Background and Objectives: Holter-based late potentials (LPs) are useful for predicting lethal arrhythmias in organic cardiac diseases. Although Holter-based LPs exhibit diurnal variation, no studies have evaluated the optimal timing of LP measurement over 24 h for predicting lethal arrhythmia that...

Descripción completa

Detalles Bibliográficos
Autores principales: Hashimoto, Kenichi, Harada, Naomi, Kimata, Motohiro, Kawamura, Yusuke, Fujita, Naoya, Sekizawa, Akinori, Ono, Yosuke, Obuchi, Yasuhiro, Takayama, Tadateru, Kasamaki, Yuji, Tanaka, Yuji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456944/
https://www.ncbi.nlm.nih.gov/pubmed/37629750
http://dx.doi.org/10.3390/medicina59081460
_version_ 1785096821034450944
author Hashimoto, Kenichi
Harada, Naomi
Kimata, Motohiro
Kawamura, Yusuke
Fujita, Naoya
Sekizawa, Akinori
Ono, Yosuke
Obuchi, Yasuhiro
Takayama, Tadateru
Kasamaki, Yuji
Tanaka, Yuji
author_facet Hashimoto, Kenichi
Harada, Naomi
Kimata, Motohiro
Kawamura, Yusuke
Fujita, Naoya
Sekizawa, Akinori
Ono, Yosuke
Obuchi, Yasuhiro
Takayama, Tadateru
Kasamaki, Yuji
Tanaka, Yuji
author_sort Hashimoto, Kenichi
collection PubMed
description Background and Objectives: Holter-based late potentials (LPs) are useful for predicting lethal arrhythmias in organic cardiac diseases. Although Holter-based LPs exhibit diurnal variation, no studies have evaluated the optimal timing of LP measurement over 24 h for predicting lethal arrhythmia that leads to sudden cardiac death. Thus, this study aimed to validate the most effective timing for Holter-based LP testing and to explore factors influencing the diurnal variability in LP parameters. Materials and Methods: We retrospectively analyzed 126 patients with post-myocardial infarction (MI) status and 60 control participants who underwent high-resolution Holter electrocardiography. Among the 126 post-MI patients, 23 developed sustained ventricular tachycardia (VT) (the MI-VT group), while 103 did not (the MI-non-VT group) during the observation period. Holter-based LPs were measured at 0:00, 4:00, 8:00, 12:00, 16:00, and 20:00, and heart rate variability analysis was simultaneously performed to investigate factors influencing the diurnal variability in LP parameters. Results: Holter-based LP parameters showed diurnal variation with significant deterioration at night and improvement during the day. Assessment at the time with the longest duration of low-amplitude signals < 40 μV in the filtered QRS complex terminus (LAS40) gave the highest receiver operating characteristics curve (area under the curve, 0.659) and the highest odds ratio (3.75; 95% confidence interval, 1.45–9.71; p = 0.006) for predicting VT. In the multiple regression analysis, heart rate and noise were significant factors affecting the LP parameters in the MI-VT and control groups. In the non-VT group, the LP parameters were significantly influenced by noise and parasympathetic heart rate variability parameters, such as logpNN50. Conclusions: For Holter-based LP measurements, the test accuracy was higher when the LP was measured at the time of the highest or worst value of LAS40. Changes in autonomic nervous system activity, including heart rate, were factors influencing diurnal variability. Increased parasympathetic activity or bradycardia may exacerbate Holter-based LP parameters.
format Online
Article
Text
id pubmed-10456944
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-104569442023-08-26 Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction Hashimoto, Kenichi Harada, Naomi Kimata, Motohiro Kawamura, Yusuke Fujita, Naoya Sekizawa, Akinori Ono, Yosuke Obuchi, Yasuhiro Takayama, Tadateru Kasamaki, Yuji Tanaka, Yuji Medicina (Kaunas) Article Background and Objectives: Holter-based late potentials (LPs) are useful for predicting lethal arrhythmias in organic cardiac diseases. Although Holter-based LPs exhibit diurnal variation, no studies have evaluated the optimal timing of LP measurement over 24 h for predicting lethal arrhythmia that leads to sudden cardiac death. Thus, this study aimed to validate the most effective timing for Holter-based LP testing and to explore factors influencing the diurnal variability in LP parameters. Materials and Methods: We retrospectively analyzed 126 patients with post-myocardial infarction (MI) status and 60 control participants who underwent high-resolution Holter electrocardiography. Among the 126 post-MI patients, 23 developed sustained ventricular tachycardia (VT) (the MI-VT group), while 103 did not (the MI-non-VT group) during the observation period. Holter-based LPs were measured at 0:00, 4:00, 8:00, 12:00, 16:00, and 20:00, and heart rate variability analysis was simultaneously performed to investigate factors influencing the diurnal variability in LP parameters. Results: Holter-based LP parameters showed diurnal variation with significant deterioration at night and improvement during the day. Assessment at the time with the longest duration of low-amplitude signals < 40 μV in the filtered QRS complex terminus (LAS40) gave the highest receiver operating characteristics curve (area under the curve, 0.659) and the highest odds ratio (3.75; 95% confidence interval, 1.45–9.71; p = 0.006) for predicting VT. In the multiple regression analysis, heart rate and noise were significant factors affecting the LP parameters in the MI-VT and control groups. In the non-VT group, the LP parameters were significantly influenced by noise and parasympathetic heart rate variability parameters, such as logpNN50. Conclusions: For Holter-based LP measurements, the test accuracy was higher when the LP was measured at the time of the highest or worst value of LAS40. Changes in autonomic nervous system activity, including heart rate, were factors influencing diurnal variability. Increased parasympathetic activity or bradycardia may exacerbate Holter-based LP parameters. MDPI 2023-08-13 /pmc/articles/PMC10456944/ /pubmed/37629750 http://dx.doi.org/10.3390/medicina59081460 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hashimoto, Kenichi
Harada, Naomi
Kimata, Motohiro
Kawamura, Yusuke
Fujita, Naoya
Sekizawa, Akinori
Ono, Yosuke
Obuchi, Yasuhiro
Takayama, Tadateru
Kasamaki, Yuji
Tanaka, Yuji
Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction
title Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction
title_full Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction
title_fullStr Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction
title_full_unstemmed Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction
title_short Diurnal Variation in and Optimal Time to Measure Holter-Based Late Potentials to Predict Lethal Arrhythmia after Myocardial Infarction
title_sort diurnal variation in and optimal time to measure holter-based late potentials to predict lethal arrhythmia after myocardial infarction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456944/
https://www.ncbi.nlm.nih.gov/pubmed/37629750
http://dx.doi.org/10.3390/medicina59081460
work_keys_str_mv AT hashimotokenichi diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT haradanaomi diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT kimatamotohiro diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT kawamurayusuke diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT fujitanaoya diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT sekizawaakinori diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT onoyosuke diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT obuchiyasuhiro diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT takayamatadateru diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT kasamakiyuji diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction
AT tanakayuji diurnalvariationinandoptimaltimetomeasureholterbasedlatepotentialstopredictlethalarrhythmiaaftermyocardialinfarction