BackgroundImplantable cardioverter defibrillator (ICD) isan effective treatment to reduce mortality in patients withsymptomatic heart failure and left ventricular ejectionfraction (LVEF) 35% or less. LVEF presents a low sensitivityfor predicting arrhythmic events. Aim of this study was toidentify predictors of sustained ventricular arrhythmias(SVAs), overall and according to the cause of heart failure.MethodsSingle-center, retrospective, cohort study of 193patients (51 nonischemic and 142 ischemic) with chronicheart failure and LVEF less than 35% who had received ICDfor primary prevention of sudden cardiac death. Wecollected clinical data, echocardiographic parameters andSVAs detected by the ICD.ResultsDuring a median follow-up of 1440 days, 32 (16.2%)patients had SVAs. SVAs incidence was similar in patientswith nonischemic (15.6%) and ischemic cause of heartfailure (16.9%). Hypertension, diabetes, chronic renalfailure, atrial fibrillation, chronic obstructive pulmonarydisease, New York Heart Association class at least III werepredictors at univariate analysis of SVAs. A clinical score,assigning one point to each of these variables, wasassociated with a significantly increased risk of SVAs [oddsratio for each point increaseU1.92, 95% confidence interval1.40 – 2.65,P< 0.0001, area under the curve (AUC) 0.73],with 72% sensitivity and 60% specificity for a cutoff at leastthree and remained significant in nonischemic (AUC 0.84)and ischemic (AUC 0.68) patients.ConclusionOur study shows the benefit of ICDimplantation in primary prevention and its independency ofcause. A simple clinical score, based on comorbidities,identifies patients with more benefits from ICD implantation.

Arrhytmic event prediction in patients with heart failure and reduced ejection fraction / G. Santangelo, F. Bursi, M.S. Negroni, D. Gentile, G. Provenzale, L. Turriziani, D.L. Zambelli, L. Fiorista, G. Bacchioni, L. Massironi, D.G. Tarricone, S. Carugo. - In: JOURNAL OF CARDIOVASCULAR MEDICINE. - ISSN 1558-2027. - 22:2(2021), pp. 110-117.

Arrhytmic event prediction in patients with heart failure and reduced ejection fraction

F. Bursi;D. Gentile;G. Provenzale;L. Fiorista;G. Bacchioni;L. Massironi;S. Carugo
Ultimo
2021

Abstract

BackgroundImplantable cardioverter defibrillator (ICD) isan effective treatment to reduce mortality in patients withsymptomatic heart failure and left ventricular ejectionfraction (LVEF) 35% or less. LVEF presents a low sensitivityfor predicting arrhythmic events. Aim of this study was toidentify predictors of sustained ventricular arrhythmias(SVAs), overall and according to the cause of heart failure.MethodsSingle-center, retrospective, cohort study of 193patients (51 nonischemic and 142 ischemic) with chronicheart failure and LVEF less than 35% who had received ICDfor primary prevention of sudden cardiac death. Wecollected clinical data, echocardiographic parameters andSVAs detected by the ICD.ResultsDuring a median follow-up of 1440 days, 32 (16.2%)patients had SVAs. SVAs incidence was similar in patientswith nonischemic (15.6%) and ischemic cause of heartfailure (16.9%). Hypertension, diabetes, chronic renalfailure, atrial fibrillation, chronic obstructive pulmonarydisease, New York Heart Association class at least III werepredictors at univariate analysis of SVAs. A clinical score,assigning one point to each of these variables, wasassociated with a significantly increased risk of SVAs [oddsratio for each point increaseU1.92, 95% confidence interval1.40 – 2.65,P< 0.0001, area under the curve (AUC) 0.73],with 72% sensitivity and 60% specificity for a cutoff at leastthree and remained significant in nonischemic (AUC 0.84)and ischemic (AUC 0.68) patients.ConclusionOur study shows the benefit of ICDimplantation in primary prevention and its independency ofcause. A simple clinical score, based on comorbidities,identifies patients with more benefits from ICD implantation.
heart failure, implantable cardioverter defibrillator, primaryprevention, sudden cardiac death
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
giu-2020
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/750315
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