Arrhythmic event prediction in patients with heart failure and reduced ejection fraction.
Aged
Defibrillators, Implantable
Echocardiography
Female
Follow-Up Studies
Heart Failure
/ complications
Heart Ventricles
/ diagnostic imaging
Humans
Italy
/ epidemiology
Male
Primary Prevention
/ methods
Prognosis
Retrospective Studies
Stroke Volume
/ physiology
Survival Rate
/ trends
Tachycardia, Ventricular
/ epidemiology
Ventricular Function, Left
/ physiology
Journal
Journal of cardiovascular medicine (Hagerstown, Md.)
ISSN: 1558-2035
Titre abrégé: J Cardiovasc Med (Hagerstown)
Pays: United States
ID NLM: 101259752
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
pubmed:
9
7
2020
medline:
15
12
2021
entrez:
9
7
2020
Statut:
ppublish
Résumé
Implantable cardioverter defibrillator (ICD) is an effective treatment to reduce mortality in patients with symptomatic heart failure and left ventricular ejection fraction (LVEF) 35% or less. LVEF presents a low sensitivity for predicting arrhythmic events. Aim of this study was to identify predictors of sustained ventricular arrhythmias (SVAs), overall and according to the cause of heart failure. Single-center, retrospective, cohort study of 193 patients (51 nonischemic and 142 ischemic) with chronic heart failure and LVEF less than 35% who had received ICD for primary prevention of sudden cardiac death. We collected clinical data, echocardiographic parameters and SVAs detected by the ICD. During a median follow-up of 1440 days, 32 (16.2%) patients had SVAs. SVAs incidence was similar in patients with nonischemic (15.6%) and ischemic cause of heart failure (16.9%). Hypertension, diabetes, chronic renal failure, atrial fibrillation, chronic obstructive pulmonary disease, New York Heart Association class at least III were predictors at univariate analysis of SVAs. A clinical score, assigning one point to each of these variables, was associated with a significantly increased risk of SVAs [odds ratio for each point increase = 1.92, 95% confidence interval 1.40-2.65, P < 0.0001, area under the curve (AUC) 0.73], with 72% sensitivity and 60% specificity for a cutoff at least three and remained significant in nonischemic (AUC 0.84) and ischemic (AUC 0.68) patients. Our study shows the benefit of ICD implantation in primary prevention and its independency of cause. A simple clinical score, based on comorbidities, identifies patients with more benefits from ICD implantation.
Identifiants
pubmed: 32639331
pii: 01244665-202102000-00007
doi: 10.2459/JCM.0000000000001058
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
110-117Informations de copyright
Copyright © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.
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