Vectorcardiography Predicts Heart Failure in Patients Following ST Elevation Myocardial Infarction.

Autor: Perkins SJ; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA., Monovoukas D; University of Michigan Medical School, Ann Arbor, Michigan, USA., Chopra Z; University of Michigan Medical School, Ann Arbor, Michigan, USA., Kucharski K; University of Michigan Medical School, Ann Arbor, Michigan, USA., Powell C; Consulting for Statistics, Computing and Analytics Research, University of Michigan, Ann Arbor, Michigan, USA., Vejalla A; University of Michigan Medical School, Ann Arbor, Michigan, USA., Latchamsetty R; Department of Internal Medicine-Division of Electrophysiology, University of Michigan, Ann Arbor, Michigan, USA., Bugga P; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA., Asthana V; Department of Internal Medicine-Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Jazyk: angličtina
Zdroj: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc [Ann Noninvasive Electrocardiol] 2024 Sep; Vol. 29 (5), pp. e70013.
DOI: 10.1111/anec.70013
Abstrakt: Background: Modeling outcomes, such as onset of heart failure (HF) or mortality, in patients following ST elevation myocardial infarction (STEMI) is challenging but clinically very useful. The acute insult following a myocardial infarction and chronic degeneration seen in HF involve a similar process where a loss of cardiomyocytes and abnormal remodeling lead to pump failure. This process may alter the strength and direction of the heart's net depolarization signal. We hypothesize that changes over time in unique parameters extracted using vectorcardiography (VCG) have the potential to predict outcomes in patients post-STEMI and could eventually be used as a noninvasive and cost-effective surveillance tool for characterizing the severity and progression of HF to guide evidence-based therapies.
Methods: We identified 162 patients discharged from Michigan Medicine between 2016 and 2021 with a diagnosis of acute STEMI. For each patient, a single 12-lead ECG > 1 week pre-STEMI and > 1 week post-STEMI were collected. A set of unique VCG parameters were derived by analyzing features of the QRS complex. We used LASSO regression analysis incorporating clinical variables and VCG parameters to create a predictive model for HF, mortality, or the composite at 90, 180, and 365 days post-STEMI.
Results: The VCG model is most predictive for HF onset at 90 days with a robust AUC. Variables from the HF model mitigating or driving risk, at a p < 0.05, were primarily parameters that assess the area swept by the depolarization vector including the 3D integral and convex hull in select spatial octants and quadrants.
(© 2024 The Author(s). Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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