Temporal variability of ECG risk markers and clinical outcomes in non-dilated left ventricular cardiomyopathy
N Milaras, K P Pamporis, S S SiderisAbstract
Background
Non-dilated left ventricular cardiomyopathy (NDLVC) is a recently defined clinical entity associated with increased risk of ventricular arrhythmias (VA) and sudden cardiac death (SCD), despite preserved LV geometry. The role and temporal variability of noninvasive electrocardiographic (ECG) risk markers in this population remain insufficiently characterized.
Objectives
To assess the temporal variability of ECG-derived risk markers in patients with NDLVC and explore their association with major adverse cardiac events, including heart failure (HF) and VA hospitalization.
Methods
We prospectively studied 55 patients with NDLVC who underwent cardiac magnetic resonance imaging and serial 24-hour Holter monitoring, signal-averaged ECG, and standard 12-lead ECG over a one-year period. Patients were followed up for 39,5±8,6 months. Nine ECG-based risk markers were analyzed, including premature ventricular contraction (PVC) burden, non-sustained ventricular tachycardia (NSVT) occurrence, its maximum rate and maximum beats, mean QTc interval, standard deviation of NN intervals (SDNN), deceleration capacity (DC), heart rate turbulence onset and slope (TO/TS), T-wave alternans (TWA), and late potentials. Clinical outcomes were HF and VA hospitalization. Logistic regression with odds ratios (OR) and 95% confidence intervals (CI) was used to evaluate associations between changes in ECG parameters and outcomes.
Results
Most ECG risk markers showed no significant change at the group level over one year, except for a modest decline in TS (p=0.018). However, 67.3% of patients experienced a change (from positive to negative and vice versa) in at least one ECG parameter, with the highest variability observed in TWA (34.5%), NSVT (23.6%), and PVC burden (23.6%). Despite this variability, only SDNN was significantly associated with increased risk of VA hospitalization (OR=0.98, 95% CI: 0.97–0.99, p=0.006). No ECG changes were associated with HF hospitalization.
Conclusions
Patients with NDLVC exhibit substantial temporal variability in noninvasive ECG risk markers. While most changes do not correlate with clinical events, an inverse association was found between SDNN and VA risk. These findings underscore the importance of ongoing evaluation and the necessity to