Combining noninvasive risk stratification parameters improves the prediction of mortality and appropriate ICD shocks.
Belgium
Cohort Studies
Death, Sudden, Cardiac
/ prevention & control
Defibrillators, Implantable
Electrocardiography
/ methods
Electrocardiography, Ambulatory
/ methods
Female
Follow-Up Studies
Heart Failure
/ diagnosis
Hospital Mortality
Hospitals, University
Humans
Male
Predictive Value of Tests
Proportional Hazards Models
ROC Curve
Registries
Retrospective Studies
Risk Reduction Behavior
Time Factors
Treatment Outcome
Ventricular Premature Complexes
/ diagnostic imaging
heart rate variability
implantable cardioverter-defibrillator
sudden cardiac death
Journal
Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
ISSN: 1542-474X
Titre abrégé: Ann Noninvasive Electrocardiol
Pays: United States
ID NLM: 9607443
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
08
06
2018
revised:
06
08
2018
accepted:
10
08
2018
pubmed:
29
9
2018
medline:
10
4
2020
entrez:
29
9
2018
Statut:
ppublish
Résumé
Sudden cardiac death (SCD) results from a complex interplay of abnormalities in autonomic function, myocardial substrate and vulnerability. We studied whether a combination of noninvasive risk stratification tests reflecting these key players could improve risk stratification. Patients implanted with an ICD in whom 24-hr holter recordings were available prior to implant were included. QRS fragmentation (fQRS) was selected as measure of myocardial substrate and a high ventricular premature beat count (VPB >10/hr) for arrhythmic vulnerability. From receiver operating characteristics analysis, detrended fluctuation analysis (DFA), turbulence slope, and deceleration capacity were selected for autonomic function. Adjusted Cox regression analysis with comparison of C-statistics was performed to predict first appropriate shock (AS) and total mortality. A total of 220 patients were included in the analysis with an overall follow-up of 4.3 ± 3.1 years. A model including VPB >10/hr, inferior fQRS, and abnormal nonedited DFA was the best for prediction of AS after 1 year of follow-up with a trends toward improvement of the C-statistics compared to baseline (p = 0.055). The risk increased significantly with every abnormal test (HR 1.793, 95%CI 1.255-2.564). A model including fQRS in any region and abnormal edited DFA was the best for prediction of mortality after 3 years of follow-up with significant improvement of the C-statistics (p = 0.023). Each abnormal test was associated with a significant increase in mortality (HR 5.069, 95%CI 1.978-12.994). Combining noninvasive risk stratification tests according to their physiological background can improve the risk prediction of SCD and mortality.
Sections du résumé
BACKGROUND
Sudden cardiac death (SCD) results from a complex interplay of abnormalities in autonomic function, myocardial substrate and vulnerability. We studied whether a combination of noninvasive risk stratification tests reflecting these key players could improve risk stratification.
METHODS
Patients implanted with an ICD in whom 24-hr holter recordings were available prior to implant were included. QRS fragmentation (fQRS) was selected as measure of myocardial substrate and a high ventricular premature beat count (VPB >10/hr) for arrhythmic vulnerability. From receiver operating characteristics analysis, detrended fluctuation analysis (DFA), turbulence slope, and deceleration capacity were selected for autonomic function. Adjusted Cox regression analysis with comparison of C-statistics was performed to predict first appropriate shock (AS) and total mortality.
RESULTS
A total of 220 patients were included in the analysis with an overall follow-up of 4.3 ± 3.1 years. A model including VPB >10/hr, inferior fQRS, and abnormal nonedited DFA was the best for prediction of AS after 1 year of follow-up with a trends toward improvement of the C-statistics compared to baseline (p = 0.055). The risk increased significantly with every abnormal test (HR 1.793, 95%CI 1.255-2.564). A model including fQRS in any region and abnormal edited DFA was the best for prediction of mortality after 3 years of follow-up with significant improvement of the C-statistics (p = 0.023). Each abnormal test was associated with a significant increase in mortality (HR 5.069, 95%CI 1.978-12.994).
CONCLUSION
Combining noninvasive risk stratification tests according to their physiological background can improve the risk prediction of SCD and mortality.
Identifiants
pubmed: 30265438
doi: 10.1111/anec.12604
pmc: PMC6931642
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e12604Subventions
Organisme : European Community's Seventh Framework Program FP7: EU-CERT-ICD
ID : HEALTH-F2-2013-602299
Pays : International
Informations de copyright
© 2018 Wiley Periodicals, Inc.
Références
Circulation. 2006 May 30;113(21):2495-501
pubmed: 16717150
J Am Coll Cardiol. 2007 Dec 11;50(24):2275-84
pubmed: 18068035
Pacing Clin Electrophysiol. 2016 Aug;39(8):848-57
pubmed: 27198580
Pacing Clin Electrophysiol. 1991 Nov;14(11 Pt 2):1986-91
pubmed: 1721212
Circulation. 2005 Jul 19;112(3):314-9
pubmed: 16009791
Can J Cardiol. 2009 Jun;25 Suppl A:21A-27A
pubmed: 19521570
Europace. 2015 Jun;17(6):969-77
pubmed: 25355781
N Engl J Med. 2002 Mar 21;346(12):877-83
pubmed: 11907286
J Am Coll Cardiol. 2009 Feb 10;53(6):471-9
pubmed: 19195603
Int J Cardiol. 2017 Sep 15;243:223-228
pubmed: 28747026
Am J Cardiol. 2013 Oct 15;112(8):1263-70
pubmed: 23927786
Circ Arrhythm Electrophysiol. 2008 Oct;1(4):258-68
pubmed: 19808417
Circ Res. 2015 Jun 5;116(12):1907-18
pubmed: 26044247
Circ Arrhythm Electrophysiol. 2016 Dec;9(12):
pubmed: 27879279
Circulation. 2000 Sep 12;102(11):1252-7
pubmed: 10982539
Heart Rhythm. 2008 Aug;5(8):1095-1102
pubmed: 18675217
Heart Rhythm. 2015 Oct;12(10):2058-66
pubmed: 26096609
Ann Noninvasive Electrocardiol. 2016 Sep;21(5):508-18
pubmed: 27038287
Circulation. 2011 May 31;123(21):2423-30
pubmed: 21632516
Ann Noninvasive Electrocardiol. 2019 Jan;24(1):e12604
pubmed: 30265438
J Electrocardiol. 2009 Nov-Dec;42(6):597-601
pubmed: 19853731