Repeating noninvasive risk stratification improves prediction of outcome in ICD patients.
autonomic function
heart rate turbulence
left ventricular ejection fraction
microvolt T-wave alternans
noninvasive risk stratification
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:
11 2020
11 2020
Historique:
received:
28
04
2020
revised:
12
06
2020
accepted:
16
06
2020
pubmed:
18
8
2020
medline:
9
10
2021
entrez:
18
8
2020
Statut:
ppublish
Résumé
Noninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter-defibrillator (ICD). The EUTrigTreat clinical study was a prospective multicenter trial including ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease. Left ventricular ejection fraction ≤40% (LVEF), premature ventricular complexes >400/24 hr (PVC), non-negative microvolt T-wave alternans (MTWA), and abnormal heart rate turbulence (HRT) were considered high risk. Tests were repeated within 12 months after inclusion. Adjusted Cox regression analysis was performed for mortality and appropriate ICD shocks. In total, 635 patients had analyzable baseline data with a median follow-up of 4.4 years. Worsening of LVEF was associated with increased mortality (HR 3.59, 95% CI 1.17-11.04), as was consistent abnormal HRT (HR 8.34, 95%CI 1.06-65.54). HRT improvement was associated with improved survival when compared to consistent abnormal HRT (HR 0.10, 95%CI 0.01-0.82). For appropriate ICD shocks, a non-negative MTWA test or high PVC count at any moment was associated with increased arrhythmic risk independent of the evolution of test results (worsening: HR 3.76 (95%CI 1.43-9.88) and HR 2.50 (95%CI 1.15-5.46); improvement: HR 2.80 (95%CI 1.03-7.61) and HR 2.45 (95%CI 1.07-5.62); consistent: HR 2.47 (95%CI 0.95-6.45) and HR 2.40 (95%CI 1.33-4.33), respectively). LVEF improvement was associated with a lower arrhythmic risk (HR 0.34, 95%CI 0.12-0.94). Repeating LVEF and HRT improved the prediction of mortality, whereas stratification of ventricular arrhythmias may be improved by repeating LVEF measurements, MTWA and ECG Holter monitoring.
Sections du résumé
BACKGROUND
Noninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter-defibrillator (ICD).
METHODS
The EUTrigTreat clinical study was a prospective multicenter trial including ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease. Left ventricular ejection fraction ≤40% (LVEF), premature ventricular complexes >400/24 hr (PVC), non-negative microvolt T-wave alternans (MTWA), and abnormal heart rate turbulence (HRT) were considered high risk. Tests were repeated within 12 months after inclusion. Adjusted Cox regression analysis was performed for mortality and appropriate ICD shocks.
RESULTS
In total, 635 patients had analyzable baseline data with a median follow-up of 4.4 years. Worsening of LVEF was associated with increased mortality (HR 3.59, 95% CI 1.17-11.04), as was consistent abnormal HRT (HR 8.34, 95%CI 1.06-65.54). HRT improvement was associated with improved survival when compared to consistent abnormal HRT (HR 0.10, 95%CI 0.01-0.82). For appropriate ICD shocks, a non-negative MTWA test or high PVC count at any moment was associated with increased arrhythmic risk independent of the evolution of test results (worsening: HR 3.76 (95%CI 1.43-9.88) and HR 2.50 (95%CI 1.15-5.46); improvement: HR 2.80 (95%CI 1.03-7.61) and HR 2.45 (95%CI 1.07-5.62); consistent: HR 2.47 (95%CI 0.95-6.45) and HR 2.40 (95%CI 1.33-4.33), respectively). LVEF improvement was associated with a lower arrhythmic risk (HR 0.34, 95%CI 0.12-0.94).
CONCLUSIONS
Repeating LVEF and HRT improved the prediction of mortality, whereas stratification of ventricular arrhythmias may be improved by repeating LVEF measurements, MTWA and ECG Holter monitoring.
Identifiants
pubmed: 32804415
doi: 10.1111/anec.12794
pmc: PMC7679829
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e12794Informations de copyright
© 2020 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.
Références
JACC Clin Electrophysiol. 2018 May;4(5):672-682
pubmed: 29798797
Int J Cardiol. 2018 Dec 1;272:102-107
pubmed: 29983251
J Am Coll Cardiol. 2015 Jul 14;66(2):101-9
pubmed: 26160626
Ann Noninvasive Electrocardiol. 2020 Nov;25(6):e12794
pubmed: 32804415
N Engl J Med. 2005 Jan 20;352(3):225-37
pubmed: 15659722
J Card Fail. 2013 Jun;19(6):426-30
pubmed: 23743493
Ann Noninvasive Electrocardiol. 2004 Jul;9(3):270-9
pubmed: 15245344
Ann Noninvasive Electrocardiol. 2019 Jan;24(1):e12604
pubmed: 30265438
J Am Coll Cardiol. 2007 Dec 11;50(24):2275-84
pubmed: 18068035
J Am Coll Cardiol. 2015 Aug 4;66(5):524-31
pubmed: 26227190
J Am Coll Cardiol. 2007 Nov 6;50(19):1896-904
pubmed: 17980258
J Am Coll Cardiol. 2008 Nov 11;52(20):1607-15
pubmed: 18992649
Heart Rhythm. 2008 Mar;5(3):348-52
pubmed: 18313590
Data Brief. 2018 Nov 09;21:2110-2116
pubmed: 30533459
J Am Coll Cardiol. 2008 Oct 21;52(17):1353-65
pubmed: 18940523
Cardiol J. 2007;14(6):561-7
pubmed: 18651522
Europace. 2012 Mar;14(3):416-22
pubmed: 22117037
N Engl J Med. 2001 Nov 15;345(20):1473-82
pubmed: 11794197
Pacing Clin Electrophysiol. 2017 Oct;40(10):1147-1159
pubmed: 28857211
Circ Arrhythm Electrophysiol. 2016 Dec;9(12):
pubmed: 27879279
J Cardiovasc Electrophysiol. 2002 May;13(5):502-12
pubmed: 12030535
Europace. 2015 Nov;17(11):1601-87
pubmed: 26318695
Lancet. 1999 Apr 24;353(9162):1390-6
pubmed: 10227219
N Engl J Med. 2002 Mar 21;346(12):877-83
pubmed: 11907286
J Am Coll Cardiol. 2014 Jun 10;63(22):2388-94
pubmed: 24727249
J Am Coll Cardiol. 2009 Feb 10;53(6):471-9
pubmed: 19195603
Heart Rhythm. 2010;7(2):229-35
pubmed: 20129299
Heart Rhythm. 2013 Jun;10(6):838-46
pubmed: 23422221