1
|
Sugawara M, Kajiyama T, Kondo Y, Nakano M, Nakano M, Kobayashi Y. Late potentials on signal-averaged electrocardiography eliminated by successful catheter ablation of premature ventricular contractions in a non-ischemic cardiomyopathy patient. HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
|
2
|
Marcos-Garcés V, Perez N, Gavara J, Lopez-Lereu MP, Monmeneu JV, Rios-Navarro C, de Dios E, Merenciano-González H, Gabaldon-Pérez A, Ferrero-De-Loma-Osorio Á, Martínez-Brotons Á, Bondanza L, Sánchez-Gómez JM, Albiach C, Nunez J, Bayés-Genís A, Chorro FJ, Ruiz-Granell R, Bodi V. Cardiac magnetic resonance outperforms echocardiography to predict subsequent implantable cardioverter defibrillator therapies in ST-segment elevation myocardial infarction patients. Front Cardiovasc Med 2023; 10:991307. [PMID: 36818338 PMCID: PMC9937054 DOI: 10.3389/fcvm.2023.991307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Implantable cardioverter defibrillators (ICD) are effective as a primary prevention measure of ventricular tachyarrhythmias in patients with ST-segment elevation myocardial infarction (STEMI) and depressed left ventricular ejection fraction (LVEF). The implications of using cardiac magnetic resonance (CMR) instead of echocardiography (Echo) to assess LVEF prior to the indication of ICD in this setting are unknown. Materials and methods We evaluated 52 STEMI patients (56.6 ± 11 years, 88.5% male) treated with ICD in primary prevention who underwent echocardiography and CMR prior to ICD implantation. ICD implantation was indicated based on the presence of heart failure and depressed LVEF (≤ 35%) by echocardiography, CMR, or both. Prediction of ICD therapies (ICD-T) during follow-up by echocardiography and CMR before ICD implantation was assessed. Results Compared to echocardiography, LVEF was lower by cardiac CMR (30.2 ± 9% vs. 37.4 ± 7.6%, p < 0.001). LVEF ≤ 35% was detected in 24 patients (46.2%) by Echo and in 42 (80.7%) by CMR. During a mean follow-up of 6.1 ± 4.2 years, 10 patients received appropriate ICD-T (3.16 ICD-T per 100 person-years): 5 direct shocks to treat very fast ventricular tachycardia or ventricular fibrillation, 3 effective antitachycardia pacing (ATP) for treatment of ventricular tachycardia, and 2 ineffective ATP followed by shock to treat ventricular tachycardia. Echo-LVEF ≤ 35% correctly predicted ICD-T in 4/10 (40%) patients and CMR-LVEF ≤ 35% in 10/10 (100%) patients. CMR-LVEF improved on Echo-LVEF for predicting ICD-T (area under the curve: 0.76 vs. 0.48, p = 0.04). Conclusion In STEMI patients treated with ICD, assessment of LVEF by CMR outperforms Echo-LVEF to predict the subsequent use of appropriate ICD therapies.
Collapse
Affiliation(s)
- Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain
| | - Nerea Perez
- INCLIVA Health Research Institute, Valencia, Spain
| | - Jose Gavara
- INCLIVA Health Research Institute, Valencia, Spain,Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Maria P. Lopez-Lereu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
| | - Jose V. Monmeneu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
| | | | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Hector Merenciano-González
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain
| | - Ana Gabaldon-Pérez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain
| | | | | | - Lourdes Bondanza
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Cristina Albiach
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Julio Nunez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain,Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain,Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco J. Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain,Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ricardo Ruiz-Granell
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Vicente Bodi
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain,INCLIVA Health Research Institute, Valencia, Spain,Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain,*Correspondence: Vicente Bodi,
| |
Collapse
|
3
|
Martin CA, Gajendragadkar PR. Scar Tissue. JACC Clin Electrophysiol 2020; 6:219-220. [DOI: 10.1016/j.jacep.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 11/26/2022]
|
4
|
Pezawas T, Burger AL, Binder T, Diedrich A. Importance of Diastolic Function for the Prediction of Arrhythmic Death: A Prospective, Observer-Blinded, Long-Term Study. Circ Arrhythm Electrophysiol 2020; 13:e007757. [PMID: 31944144 DOI: 10.1161/circep.119.007757] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with ischemic or dilated cardiomyopathy and reduced left ventricular ejection fraction (LVEF) face a high risk for ventricular arrhythmias. Exact grading of diastolic function might improve risk stratification for arrhythmic death. METHODS We prospectively enrolled 120 patients with ischemic, 60 patients with dilated cardiomyopathy, and 30 patients with normal LVEF. Diastolic function was graded normal (N) or dysfunction grade I to III. Primary outcome parameter was arrhythmic death (AD) or resuscitated cardiac arrest (RCA). RESULTS Normal diastolic function was found in 23 (11%) patients, dysfunction grade I in 107 (51%), grade II in 31 (14.8%), and grade III in 49 (23.3%) patients, respectively. After an average follow-up of 7.0±2.6 years, AD or RCA was observed in 28 (13.3%) and 33 (15.7%) patients, respectively. Nonarrhythmic death was found in 41 (19.5%) patients. On Kaplan-Meier analysis, patients with dysfunction grade III had the highest risk for AD or RCA (P<0.001). This finding was independent from the degree of LVEF dysfunction and was observed in patients with LVEF≤35% (P=0.001) and with LVEF>35% (P=0.014). Nonarrhythmic mortality was the highest in patients with dysfunction grade III. This was true for patients with LVEF≤35% (P=0.009) or >35% (P<0.001). In an adjusted model for relevant confounding factors, grade III dysfunction was associated with a 3.5-fold increased risk for AD or RCA in the overall study population (hazard ratio=3.52; P<0.001). CONCLUSIONS Diastolic dysfunction is associated with a high risk for AD or RCA regardless if LVEF is ≤35% or >35%. Diastolic function grading might improve risk stratification for AD.
Collapse
Affiliation(s)
- Thomas Pezawas
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria (T.P., A.L.B., T.B.)
| | - Achim Leo Burger
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria (T.P., A.L.B., T.B.)
| | - Thomas Binder
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Austria (T.P., A.L.B., T.B.)
| | - André Diedrich
- Departments of Medicine, Clinical Pharmacology, Pharmacology, and Neurology, Vanderbilt Autonomic Dysfunction Center, Nashville, TN (A.D.)
| |
Collapse
|
5
|
Kazama I, Takamura K, Yamada Y, Sugisaki Y, Suzuki M. Reciprocal ST segment changes reproduced in burn-induced subepicardial injury model in bullfrog heart. J Vet Med Sci 2019; 82:143-147. [PMID: 31827015 PMCID: PMC7041995 DOI: 10.1292/jvms.19-0597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In our previous studies, by simply inducing burn injuries on bullfrog hearts or partially
exposing their surface to high-potassium (K+) solution, we could reproduce a ST
segment elevation in the electrocardiogram (ECG), which is a characteristic finding in
human ischemic heart disease. In the present study, using our burn-induced subepicardial
injury model, we could additionally reproduce “reciprocal” ST segment changes for the
first time in frog hearts, mimicking those observed in human acute myocardial infarction.
Immunohistochemistry demonstrated markedly decreased Na+/K+-ATPase
protein expression in the ventricular surface after the burn injury. The loss of this pump
expression in injured cardiomyocytes was thought to be responsible for the creation of
“currents of injury” and the subsequent ST segment changes observed in acute myocardial
infarction.
Collapse
Affiliation(s)
- Itsuro Kazama
- School of Nursing, Miyagi University, Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi 981-3298, Japan
| | - Kano Takamura
- School of Nursing, Miyagi University, Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi 981-3298, Japan
| | - Yukina Yamada
- School of Nursing, Miyagi University, Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi 981-3298, Japan
| | - Yui Sugisaki
- School of Nursing, Miyagi University, Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi 981-3298, Japan
| | - Mayu Suzuki
- School of Nursing, Miyagi University, Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi 981-3298, Japan
| |
Collapse
|
6
|
Goldenberg I, Huang DT, Nielsen JC. The role of implantable cardioverter-defibrillators and sudden cardiac death prevention: indications, device selection, and outcome. Eur Heart J 2019; 41:2003-2011. [DOI: 10.1093/eurheartj/ehz788] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 10/26/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Multiple randomized multicentre clinical trials have established the role of the implantable cardioverter-defibrillator (ICD) as the mainstay in the treatment of ventricular tachyarrhythmias and sudden cardiac death (SCD) prevention. These trials have focused mainly on heart failure patients with advanced left ventricular dysfunction and were mostly conducted two decades ago, whereas a more recent trial has provided conflicting results. Therefore, much remains to be determined on how best to balance the identification of patients at high risk of SCD together with who would benefit most from ICD implantation in a contemporary setting. Implantable cardioverter-defibrillators have also evolved from the simple, defibrillation-only devices implanted surgically to more advanced technologies of multi-chamber devices, with physiologic bradycardic pacing, including cardiac resynchronization therapy, atrial and ventricular therapeutic pacing algorithms, and subcutaneous ICDs. These multiple options necessitate individualized approach to device selection and programming. This review will focus on the current knowledge on selection of patients for ICD treatment, device selection and programming, and future directions of implantable device therapy for SCD prevention.
Collapse
Affiliation(s)
- Ilan Goldenberg
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - David T Huang
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| |
Collapse
|
7
|
Abstract
Sudden cardiac death (SCD) accounts for ∼50% of mortality after myocardial infarction (MI). Most SCDs result from ventricular tachyarrhythmias, and the tachycardias that precipitate cardiac arrest result from multiple mechanisms. As a result, it is highly unlikely that any single test will identify all patients at risk for SCD. Current guidelines for use of implantable cardioverter-defibrillators (ICDs) to prevent SCD are based primarily on measurement of left ventricular ejection fraction (LVEF). Although reduced LVEF is associated with increased total cardiac mortality after MI, the focus of current guidelines on LVEF omits ∼50% of patients who die suddenly. In addition, there is no evidence of a mechanistic link between reduced LVEF and arrhythmias. Thus, LVEF is neither sensitive nor specific as a tool for post-MI risk stratification. Newer tests to screen for predisposition to ventricular arrhythmias and SCD examine abnormalities of ventricular repolarization, autonomic nervous system function, and electrical heterogeneity. These tests, as well as older methods such as programmed stimulation, the signal-averaged electrocardiogram, and spontaneous ventricular ectopy, do not perform well in patients with LVEF ≤30%. Recent observational studies suggest, however, that these tests may have greater utility in patients with LVEF >30%. Because SCD results from multiple mechanisms, it is likely that combinations of risk factors will prove more precise for risk stratification. Prospective trials that evaluate the performance of risk stratification schema to determine ICD use are necessary for cost-effective reduction of the incidence of SCD after MI.
Collapse
Affiliation(s)
- Jonathan W Waks
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115.,Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215; ;
| | - Alfred E Buxton
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115.,Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215; ;
| |
Collapse
|
8
|
Velasquez A, Goldberger JJ. Risk stratification for sudden cardiac death: show me the money! Eur Heart J 2019; 40:2950-2952. [PMID: 31230065 DOI: 10.1093/eurheartj/ehz410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alex Velasquez
- Division of Cardiology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA
| | - Jeffrey J Goldberger
- Division of Cardiology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, USA
| |
Collapse
|
9
|
Affiliation(s)
- T. Jared Bunch
- Intermountain Medical Center Heart Institute, Murray, UT. Department of Internal Medicine, Stanford University, Palo Alto, CA
| |
Collapse
|
10
|
Jiménez-Pavón D, Lavie CJ, Blair SN. The role of cardiorespiratory fitness on the risk of sudden cardiac death at the population level: A systematic review and meta-analysis of the available evidence. Prog Cardiovasc Dis 2019; 62:279-287. [PMID: 31075278 DOI: 10.1016/j.pcad.2019.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 02/03/2023]
Abstract
Cardiorespiratory fitness (CRF) has been widely studied as a powerful and independent predictor of all-cause and disease-specific mortality. Sudden cardiac death (SCD) is recognized as a significant cause of mortality among the general population, including the general population without previous symptoms of any coronary heart disease (CHD). Consequently, SCD is an important public health problem, which constitutes a clinical challenge. Thus, prevention of SCD by detecting early risk factors could be a useful tool, contributing to the American Heart Association's goal of decreasing the incidence of SCD at the population level. The identification of these risk factors for CVD would facilitate the large-scale screening of those participants at higher risk of SCD. This systematic review collects information about the role of CRF on the risk of SCD at the available evidence, and analyzes the long-term influence of CRF as a risk factor and independent predictor of SCD.
Collapse
Affiliation(s)
- David Jiménez-Pavón
- MOVE-IT Research Group and Department of Physical Education, Faculty of Education Sciences University of Cádiz, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Spain.
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland's School of Medicine, New Orleans, LA
| | - Steven N Blair
- Department of Exercise Sciences, University of South Carolina, Columbia, SC
| |
Collapse
|
11
|
Wang S, Gao H, Ru Z, Zou Y, Li Y, Cao W, Meng W, Li J, Yao Y, Zhang Y, Lang X, Zhang Y. Poor Sleep Quality Associated With High Risk Of Ventricular Tachycardia After Acute Myocardial Infarction. Nat Sci Sleep 2019; 11:281-289. [PMID: 31802960 PMCID: PMC6827508 DOI: 10.2147/nss.s222359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/24/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sleep disorders (SDs) are usually associated with an increase in frequency of ventricular tachycardia (VT). However, the relationship between SDs and the prevalence of VT within the first week of acute myocardial infarction (AMI) remains unclear. This study aimed to evaluate their associations and potential mechanisms. METHODS This structured questionnaire-based cross-sectional study enrolled 303 patients with AMI from a hospital in northern China. Pittsburgh Sleep Quality Index (PSQI) was used to determine sleep quality of subjects. Heart rate variability (HRV) of patients was investigated by ambulatory electrocardiography recorders. Enzyme-linked immunosorbent assay was used to measure the plasma levels of catecholamine in a subgroup including 80 patients with AMI. RESULTS After adjusting to basic cardiovascular characteristics, results of multivariate logistic regression demonstrated that the global PSQI score and its main components were positively associated with VT prevalence in inpatients with AMI. There were significantly different HRV parameters interpreted as autonomic nerve activity in two groups of AMI patients with different sleep quality. In addition, we found the influence of sleep quality on plasma concentrations of adrenaline and norepinephrine in AMI patients. CONCLUSION Sleep status was significantly associated with the initiation of VT within the first week of AMI, probably due to the effect of SDs on sympathetic nerve activity. Amelioration of sleep quality and sympathetic hyperactivity may be prospective strategy to curb arrhythmias after AMI.
Collapse
Affiliation(s)
- Shipeng Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin 150086, People's Republic of China
| | - Hui Gao
- Department of Cardiology, People' Hospital of Xinzheng, Xinzheng, Henan Province 451150, People's Republic of China
| | - Zewen Ru
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yanan Zou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yilan Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Wei Cao
- Department of Cardiology, Heilongjiang Provincial Hospital Affiliated to Harbin Institute of Technology, Harbin 150036, People's Republic of China
| | - Wei Meng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Jihe Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Yuan Yao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yanxiu Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Xueyan Lang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China
| | - Yao Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, People's Republic of China.,Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin 150086, People's Republic of China
| |
Collapse
|
12
|
2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
|
13
|
Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e210-e271. [PMID: 29084733 DOI: 10.1161/cir.0000000000000548] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| |
Collapse
|
14
|
Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| |
Collapse
|
15
|
Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 717] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
16
|
Vohra J, Haqqani HM. The epidemiology and costs of implantable cardioverter-defibrillator therapy in Australia. Med J Aust 2018; 209:116-117. [PMID: 30071815 DOI: 10.5694/mja18.00601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022]
|
17
|
Gatzoulis KA, Arsenos P, Trachanas K, Dilaveris P, Antoniou C, Tsiachris D, Sideris S, Kolettis TM, Tousoulis D. Signal-averaged electrocardiography: Past, present, and future. J Arrhythm 2018; 34:222-229. [PMID: 29951136 PMCID: PMC6010001 DOI: 10.1002/joa3.12062] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/28/2018] [Indexed: 01/12/2023] Open
Abstract
Signal-averaged electrocardiography records delayed depolarization of myocardial areas with slow conduction that can form the substrate for monomorphic ventricular tachycardia. This technique has been examined mostly in patients with coronary artery disease, but its use has been declined over the years. However, several lines of evidence, derived from hitherto clinical data in patients with healed myocardial infarction, indicate that signal-averaged electrocardiography remains a valuable tool in risk stratification, especially when incorporated into algorithms encompassing invasive and noninvasive indices. Such an approach can aid the more precise identification of candidates for device therapy, in the context of primary prevention of sudden cardiac death. This article reappraises the value of signal-averaged electrocardiography as a predictor of arrhythmic outcome in patients with ischemic heart disease and discusses potential future indications.
Collapse
Affiliation(s)
- Konstantinos A. Gatzoulis
- Electrophysiology Laboratory and First University Department of CardiologyHippokration General HospitalNational and Kapodestrian University of AthensAthensGreece
| | - Petros Arsenos
- Electrophysiology Laboratory and First University Department of CardiologyHippokration General HospitalNational and Kapodestrian University of AthensAthensGreece
| | | | - Polychronis Dilaveris
- Electrophysiology Laboratory and First University Department of CardiologyHippokration General HospitalNational and Kapodestrian University of AthensAthensGreece
| | - Christos Antoniou
- Electrophysiology Laboratory and First University Department of CardiologyHippokration General HospitalNational and Kapodestrian University of AthensAthensGreece
| | | | - Skevos Sideris
- Department of CardiologyHippokration General HospitalAthensGreece
| | - Theofilos M. Kolettis
- Department of CardiologyUniversity of IoanninaIoanninaGreece
- Cardiovascular Research InstituteIoanninaGreece
| | - Dimitrios Tousoulis
- Electrophysiology Laboratory and First University Department of CardiologyHippokration General HospitalNational and Kapodestrian University of AthensAthensGreece
| |
Collapse
|
18
|
Daniłowicz-Szymanowicz L, Kaufmann D, Rozwadowska K, Kempa M, Lewicka E, Raczak G. Microvolt T-wave alternans and autonomic nervous system parameters can be helpful in the identification of low-arrhythmic risk patients with ischemic left ventricular systolic dysfunction. PLoS One 2018; 13:e0196812. [PMID: 29723261 PMCID: PMC5933691 DOI: 10.1371/journal.pone.0196812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/22/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The role of implantable cardioverter-defibrillator (ICD) placement in the primary prevention of sudden cardiac death (SCD) in all consecutive patients with left ventricular ejection fraction (LVEF) ≤ 35% is still a matter of hot debate due to the fact that the population of these patients is highly heterogeneous in terms of the SCD risk. Nevertheless, reduced LVEF is still the only established criterion during qualification of patients for ICD implantation in the primary prevention of SCD, therefore identification of persons with particularly high risk among patients with LVEF ≤35% is currently of lesser importance. More important seems to be the selection of individuals with relatively low risk of SCD in whom ICD implantation can be safely postponed. The aim of the study was to determine whether well-known, non-invasive parameters, such as microvolt T-wave alternans (MTWA), baroreflex sensitivity (BRS) and short-term heart rate variability (HRV), can be helpful in the identification of low-arrhythmic risk patients with ischemic left ventricular systolic dysfunction. METHODS In 141 patients with coronary artery disease and LVEF ≤ 35%, MTWA testing, as well as BRS and short-term HRV parameters, were analysed. During 34 ± 13 months of follow-up 37 patients had arrhythmic episode (EVENT): SCD, non-fatal sustained ventricular arrhythmia (ventricular tachycardia [VT] or ventricular fibrillation [VF]), or adequate high-voltage ICD intervention (shock) due to a rapid ventricular arrhythmia ≥200/min. LVEF, non-negative MTWA (MTWA_non-neg), BRS and low frequency power in normalized units (LFnu) turned out to be associated with the incidence of EVENT in univariate Cox analysis. The cut-off values for BRS and LFnu that most accurately distinguished between patients with and without EVENT were 3 ms/mmHg and 23, respectively. The only variable that provided 100% negative predictive value (NPV) for EVENT was negative MTWA result (MTWA_neg), but solely for initial 12 months of the follow-up; the NPVs for other potential predictors of the EVENT were lower. The cut-off values for BRS and LFnu that provide 100% NPV for EVENT during 12 and 24 months were higher: 6.0 ms/mmHg and 73 respectively, but the gain in the NPV occurred at an expense of the number of identified patients. However, the number of identified non-risk patients turned out to be higher when the predictive model included MTWA_neg and the lower cut-off values for ANS parameters: 100% NPV for 12 and 24 months of follow-up was obtained for combination MTWA_neg and BRS ≥ 3 ms/mmHg, for combination MTWA_neg and LFnu ≥ 23 100% NPV was obtained for 12 months. CONCLUSION Well-known, non-invasive parameters, such as MTWA, BRS and short-term HRV indices may be helpful in the identification of individuals with a relatively low risk of malignant ventricular arrhythmias among patients with ischemic left ventricular systolic dysfunction; in such persons, implantation of ICD could be safely postponed.
Collapse
Affiliation(s)
| | - Damian Kaufmann
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Rozwadowska
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
19
|
Kon N, Abe N, Miyazaki M, Mushiake H, Kazama I. Partial exposure of frog heart to high-potassium solution: an easily reproducible model mimicking ST segment changes. J Vet Med Sci 2018; 80:578-582. [PMID: 29503350 PMCID: PMC5938182 DOI: 10.1292/jvms.18-0010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
By simply inducing burn injuries on the bullfrog heart, we previously reported a simple
model of abnormal ST segment changes observed in human ischemic heart disease. In the
present study, instead of inducing burn injuries, we partially exposed the surface of the
frog heart to high-potassium (K+) solution to create a concentration gradient
of the extracellular K+ within the myocardium. Dual recordings of ECG and the
cardiac action potential demonstrated significant elevation of the ST segment and the
resting membrane potential, indicating its usefulness as a simple model of heart injury.
Additionally, from our results, Na+/K+-ATPase activity was thought
to be primarily responsible for generating the K+ concentration gradient and
inducing the ST segment changes in ECG.
Collapse
Affiliation(s)
- Nobuaki Kon
- Department of Physiology, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Nozomu Abe
- Department of Physiology, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8575, Japan.,Department of Anesthesiology, Tohoku University Hospital, Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Masahiro Miyazaki
- Department of Physiology, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hajime Mushiake
- Department of Physiology, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Itsuro Kazama
- School of Nursing, Miyagi University, Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi 981-3298, Japan.,Department of Physiology, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| |
Collapse
|
20
|
Bui AH, Waks JW. Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction. J Innov Card Rhythm Manag 2018; 9:3035-3049. [PMID: 32477797 PMCID: PMC7252689 DOI: 10.19102/icrm.2018.090201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/02/2017] [Indexed: 01/20/2023] Open
Abstract
Despite advances in the diagnosis and treatment of acute coronary syndromes and an overall improvement in outcomes, mortality after myocardial infarction (MI) remains high. Sudden death, which is most frequently due to ventricular tachycardia or ventricular fibrillation, is the cause of death in 25% to 50% of patients with prior MI, and therefore represents an important public health problem. Use of the implantable cardioverter-defibrillator (ICD), which is the primary method of reducing the chance of arrhythmic sudden death after MI, is costly to the medical system and is associated with procedural and long-term risks. Additionally, assessment of left ventricular ejection fraction (LVEF), which is the primary method of assessing a patient's post-MI sudden death risk and appropriateness for ICD implantation, lacks both sensitivity and specificity for sudden death, and may not be the optimal way to select the subgroup of post-MI patients who are most likely to benefit from ICD implantation. To optimally utilize ICDs, it is therefore critical to develop and prospectively validate sudden death risk stratification methods beyond measuring LVEF. A variety of tests that assess left ventricular systolic function/morphology, potential triggers for ventricular arrhythmias, ventricular conduction/repolarization, and autonomic tone have been proposed as sudden death risk stratification tools. Multivariable models have also been developed to assess the competing risks of arrhythmic and non-arrhythmic death so that ICDs can be utilized more effectively. This manuscript will review the epidemiology of sudden death after MI, and will discuss the current state of sudden death risk stratification in this population.
Collapse
Affiliation(s)
- An H. Bui
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan W. Waks
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
21
|
Macatangay C, Viles-Gonzalez JF, Goldberger JJ. Role of Cardiac Imaging in Evaluating Risk for Sudden Cardiac Death. Card Electrophysiol Clin 2017; 9:639-650. [PMID: 29173407 DOI: 10.1016/j.ccep.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sudden cardiac death (SCD) is a major cause of death from cardiovascular disease. Our ability to predict patients at the highest risk of developing lethal ventricular arrhythmias remains limited. Despite recent studies evaluating risk stratification tools, there is no optimal strategy. Cardiac imaging provides the opportunity to assess left ventricular ejection fraction, strain, fibrosis, and sympathetic innervation, all of which are pathophysiologically related to SCD risk. These modalities may play a role in the identification of vulnerable anatomic substrates that provide the pathophysiologic basis for SCD. Further studies are required to identify optimal imaging platform for risk assessment.
Collapse
Affiliation(s)
- Constancia Macatangay
- Cardiovascular Division, Department of Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136, USA
| | - Juan F Viles-Gonzalez
- Cardiovascular Division, Department of Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136, USA
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136, USA.
| |
Collapse
|
22
|
Arrhythmic risk stratification in non-ischemic dilated cardiomyopathy: Where do we stand after DANISH? Trends Cardiovasc Med 2017; 27:542-555. [DOI: 10.1016/j.tcm.2017.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/21/2017] [Accepted: 06/02/2017] [Indexed: 12/13/2022]
|
23
|
Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2017; 72:1677-1749. [PMID: 29097294 DOI: 10.1016/j.jacc.2017.10.053] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
24
|
Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 15:e190-e252. [PMID: 29097320 DOI: 10.1016/j.hrthm.2017.10.035] [Citation(s) in RCA: 392] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 12/23/2022]
|
25
|
Gatzoulis KA, Sideris A, Kanoupakis E, Sideris S, Nikolaou N, Antoniou CK, Kolettis TM. Arrhythmic risk stratification in heart failure: Time for the next step? Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28252256 DOI: 10.1111/anec.12430] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/10/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary prevention of sudden cardiac death by means of implantable cardioverter-defibrillators constitutes the holy grail of arrhythmology. However, current risk stratification algorithms lead to suboptimal outcomes, by both allocating ICDs to patients not deriving any meaningful survival benefit and withholding them from those erroneously considered as low-risk for arrhythmic mortality. METHODS In the present review article we will attempt to present shortcomings of contemporary guidelines regarding sudden death prevention in ischemic and dilated cardiomyopathy patients and present available data suggesting encouraging results following implementation of multifactorial approaches, by using multiple modalities, both noninvasive and invasive. Invasive electrophysiological testing, namely programmed ventricular stimulation, will be discussed in greater length to highlight both its potential usefulness and currently ongoing multicenter studies aiming to provide evidence necessary to make the next step in sudden death risk stratification. RESULTS Promising findings have been reported by multiple study groups regarding novel strategies for both negative selection of low and positive selection of relatively preserved ejection fraction patients as candidates for ICD implantation. CONCLUSIONS The era of ejection fraction as the sole risk stratifier for arrhythmic risk in heart failure appears to be drawing to an end, especially if current underway large studies validate previous findings.
Collapse
Affiliation(s)
- Konstantinos A Gatzoulis
- Electrophysiology Laboratory, First Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, University General Hospital of Heraklion, Heraklion, Greece
| | - Skevos Sideris
- State Department of Cardiology, "Hippokration" General Hospital, Athens, Greece
| | - Nikolaos Nikolaou
- Department of Cardiology, "Konstantopouleio" General Hospital, Athens, Greece
| | - Christos-Konstantinos Antoniou
- Electrophysiology Laboratory, First Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theofilos M Kolettis
- Department of Cardiology, University General Hospital of Ioannina, Ioannina, Greece
| |
Collapse
|
26
|
Mikami Y, Jolly U, Heydari B, Peng M, Almehmadi F, Zahrani M, Bokhari M, Stirrat J, Lydell CP, Howarth AG, Yee R, White JA. Right Ventricular Ejection Fraction Is Incremental to Left Ventricular Ejection Fraction for the Prediction of Future Arrhythmic Events in Patients With Systolic Dysfunction. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004067. [DOI: 10.1161/circep.116.004067] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 11/14/2016] [Indexed: 01/12/2023]
Abstract
Background—
Left ventricular ejection fraction remains the primary risk stratification tool used in the selection of patients for implantable cardioverter defibrillator therapy. However, this solitary marker fails to identify a substantial portion of patients experiencing sudden cardiac arrest. In this study, we examined the incremental value of considering right ventricular ejection fraction for the prediction of future arrhythmic events in patients with systolic dysfunction using the gold standard of cardiovascular magnetic resonance.
Methods and Results—
Three hundred fourteen consecutive patients with ischemic cardiomyopathy or nonischemic dilated cardiomyopathy undergoing cardiovascular magnetic resonance were followed for the primary outcome of sudden cardiac arrest or appropriate implantable cardioverter defibrillator therapy. Blinded quantification of left ventricular and right ventricular (RV) volumes was performed from standard cine imaging. Quantification of fibrosis from late gadolinium enhancement imaging was incrementally performed. RV dysfunction was defined as right ventricular ejection fraction ≤45%. Among all patients (164 ischemic cardiomyopathy, 150 nonischemic dilated cardiomyopathy), the mean left ventricular ejection fraction was 32±12% (range, 6–54%) with mean right ventricular ejection fraction of 48±15% (range, 7–78%). At a median of 773 days, 49 patients (15.6%) experienced the primary outcome (9 sudden cardiac arrest, 40 appropriate implantable cardioverter defibrillator therapies). RV dysfunction was independently predictive of the primary outcome (hazard ratio=2.98;
P
=0.002). Among those with a left ventricular ejection fraction >35% (N=121; mean left ventricular ejection fraction, 45±6%), RV dysfunction provided an adjusted hazard ratio of 4.2 (
P
=0.02).
Conclusions—
RV dysfunction is a strong, independent predictor of arrhythmic events. Among patients with mild to moderate LV dysfunction, a cohort greatly contributing to global sudden cardiac arrest burden, this marker provides robust discrimination of high- versus low-risk subjects.
Collapse
Affiliation(s)
- Yoko Mikami
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Umjeet Jolly
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Bobak Heydari
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Mingkai Peng
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Fahad Almehmadi
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Mohammed Zahrani
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Mahmoud Bokhari
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - John Stirrat
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Carmen P. Lydell
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Andrew G. Howarth
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - Raymond Yee
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| | - James A. White
- From the Stephenson Cardiac Imaging Centre (Y.M., B.H., C.P.L., A.G.H., J.W.) and Department of Cardiac Sciences (Y.M., B.H., M.P., C.P.L., A.G.H., J.W.), Libin Cardiovascular Institute of Alberta, University of Calgary, Canada; Department of Diagnostic Imaging, University of Calgary, Alberta, Canada (B.H., C.P.L., A.G.H., J.W.); and Department of Medicine, London Health Sciences Centre, Ontario, Canada (U.J., F.A., M.Z., M.B., J.S., R.Y.)
| |
Collapse
|
27
|
Bailey JJ, Hodges M, Church TR. Decision to Implant a Cardioverter Defibrillator after Myocardial Infarction: The Role of Ejection Fraction v. Other Risk Factor Markers. Med Decis Making 2016; 27:151-60. [PMID: 17409365 DOI: 10.1177/0272989x06297392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background . The Multicenter Automatic Defibrillator Implantation Trial showed that in post—myocardial infarction patients with a left ventricular ejection fraction (EF) ≤ 0.30, an implantable cardioverter defibrillator (ICD) resulted in a 31% relative reduction in the risk of death when compared with a conventional therapy group. Whether further refinement in risk estimation could be achieved with additional clinical testing to qualify patients for primary prevention with ICDs remains problematic. Methods . The authors analyzed Cardiac Arrhythmia Suppression Trial registry data to estimate sensitivity and specificity of EF, ventricular premature frequency, and nonsustained ventricular tachycardia for predicting death. They combined the results with similar data from the literature and used summarizing receiver operating characteristic (meta-ROC) curves to estimate overall operational values for sensitivity and specificity for each clinical test. They estimated aggregate values for prior probability to project risks when tests were used singly and in combination. Results . The authors used arrhythmia markers and heart rate variability to further stratify low-EF patients (prior risk = 20.3%); proportionately, 20.4% were predicted at high risk (> 30%) and 40.5% at low risk (< 10%). When heart rate variability is normal, those at high risk reduced proportionately to 9.2%, and those at low risk increased to 51.6%. Conclusions . The combined use of noninvasive markers for arrhythmia substrate and altered autonomic tone can improve risk stratification in low EF without optimal beta-block therapy, whereas for those with optimal beta-block therapy, markers for arrhythmia substrate alone work. Ancillary use of electrophysiologic stimulation can improve results.
Collapse
Affiliation(s)
- James J Bailey
- Center for Information Technology, National Institutes of Health, Bethesda, Maryland 20892-5620, USA.
| | | | | |
Collapse
|
28
|
Disertori M, Gulizia MM, Casolo G, Delise P, Di Lenarda A, Di Tano G, Lunati M, Mestroni L, Salerno-Uriarte J, Tavazzi L. Improving the appropriateness of sudden arrhythmic death primary prevention by implantable cardioverter-defibrillator therapy in patients with low left ventricular ejection fraction. Point of view. J Cardiovasc Med (Hagerstown) 2016; 17:245-55. [PMID: 26895401 PMCID: PMC4768631 DOI: 10.2459/jcm.0000000000000368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/10/2016] [Accepted: 01/22/2016] [Indexed: 12/12/2022]
Abstract
It is generally accepted that the current guidelines for the primary prevention of sudden arrhythmic death, which are based on ejection fraction, do not allow the optimal selection of patients with low left ventricular ejection fraction of ischemic and nonischemic etiology for implantation of a cardioverter-defibrillator. Ejection fraction alone is limited in both sensitivity and specificity. An analysis of the risk of sudden arrhythmic death with a combination of multiple tests (ejection fraction associated with one or more arrhythmic risk markers) could partially compensate for these limitations. We propose a polyparametric approach for defining the risk of sudden arrhythmic death using ejection fraction in combination with other clinical and arrhythmic risk markers (i.e. late gadolinium enhancement cardiac magnetic resonance, T-wave alternans, programmed ventricular stimulation, autonomic tone, and genetic testing) that have been validated in nonrandomized trials. In this article, we examine these approaches to identify three subsets of patients who cannot be comprehensively assessed by the current guidelines: patients with ejection fraction of 35% or less and a relatively low risk of sudden arrhythmic death despite the ejection fraction value; patients with ejection fraction of 35% or less and high competitive risk of death due to evolution of heart failure or noncardiac causes; and patients with ejection fraction between 35 and 45% with relatively high risk of sudden arrhythmic death despite the ejection fraction value.
Collapse
MESH Headings
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Humans
- Primary Prevention/methods
- Stroke Volume/physiology
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
Collapse
Affiliation(s)
- Marcello Disertori
- Cardiology Department, S. Chiara Hospital – Healthcare Research and Innovation Program, PAT-FBK, Trento
| | | | | | - Pietro Delise
- Division of Cardiology, Pederzoli Hospital, Peschiera del Garda (VR)
| | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Servizi Sanitari N.1 – University of Trieste, Trieste
| | | | - Maurizio Lunati
- Cardiology Department, Niguarda Ca’ Granda Hospital, Milano, Italy
| | - Luisa Mestroni
- Cardiovascular Institute, University of Colorado Denver AMC, Aurora, Colorado, USA
| | - Jorge Salerno-Uriarte
- Department of Heart Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese
| | - Luigi Tavazzi
- GVM, Maria Cecilia Hospital, Care and Research – ES Health Science Foundation, Cotignola (RA), Italy
| |
Collapse
|
29
|
Goldberger JJ, Hendel RC. Decision Making for Implantable Cardioverter Defibrillator Implantation: Is There a Role for Neurohumoral Imaging? Circ Cardiovasc Imaging 2016; 8:CIRCIMAGING.115.004275. [PMID: 26666382 DOI: 10.1161/circimaging.115.004275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeffrey J Goldberger
- From the Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL.
| | - Robert C Hendel
- From the Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, FL
| |
Collapse
|
30
|
Liew R. Sudden Cardiac Death Risk Stratification - An Update. Eur Cardiol 2015; 10:118-122. [PMID: 30310436 PMCID: PMC6159393 DOI: 10.15420/ecr.2015.10.2.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/28/2015] [Indexed: 11/04/2022] Open
Abstract
Sudden cardiac death (SCD) remains a major public health problem worldwide, yet current methods to identify those at greatest risk are inadequate. High-risk individuals may benefit from potentially life-saving treatment, such as insertion of an implantable-cardioverter defibrillator (ICD). However, such treatments are expensive and have their own associated risks. Furthermore, most cases of SCD occur in the general adult population who may be relatively asymptomatic but yet have an underlying predisposition to SCD. Hence, there is great interest and clinical need in improving methods for risk stratification of SCD to identify those at greatest risk and implement the most appropriate treatment. This review provides an update on current risk-stratification methods for SCD in high-risk groups, in particular patients with reduced left ventricular function following acute myocardial infarction and those with non-ischaemic dilated cardiomyopathy, and highlights some novel methods that may have a role to play in future risk-stratification schemes. Approaches and challenges for SCD risk stratification among the general public are also discussed.
Collapse
Affiliation(s)
- Reginald Liew
- Gleneagles Hospital Singapore, Duke-NUS Graduate Medical School, Singapore
| |
Collapse
|
31
|
Low left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation of persistent atrial fibrillation. J Cardiol 2015; 66:377-81. [DOI: 10.1016/j.jjcc.2015.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/31/2015] [Accepted: 04/14/2015] [Indexed: 11/21/2022]
|
32
|
Cikes M, Solomon SD. Beyond ejection fraction: an integrative approach for assessment of cardiac structure and function in heart failure. Eur Heart J 2015; 37:1642-50. [PMID: 26417058 DOI: 10.1093/eurheartj/ehv510] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/07/2015] [Indexed: 12/28/2022] Open
Abstract
Left ventricular ejection fraction (LVEF) has been the central parameter used for diagnosis and management in patients with heart failure. A good predictor of adverse outcomes in heart failure when below ∼45%, LVEF is less useful as a marker of risk as it approaches normal. As a measure of cardiac function, ejection fraction has several important limitations. Calculated as the stroke volume divided by end-diastolic volume, the estimation of ejection fraction is generally based on geometric assumptions that allow for assessment of volumes based on linear or two-dimensional measurements. Left ventricular ejection fraction is both preload- and afterload-dependent, can change substantially based on loading conditions, is only moderately reproducible, and represents only a single measure of risk in patients with heart failure. Moreover, the relationship between ejection fraction and risk in patients with heart failure is modified by factors such as hypertension, diabetes, and renal function. A more complete evaluation and understanding of left ventricular function in patients with heart failure requires a more comprehensive assessment: we conceptualize an integrative approach that incorporates measures of left and right ventricular function, left ventricular geometry, left atrial size, and valvular function, as well as non-imaging factors (such as clinical parameters and biomarkers), providing a comprehensive and accurate prediction of risk in heart failure.
Collapse
Affiliation(s)
- Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
33
|
Kazama I. Burn-induced subepicardial injury in frog heart: a simple model mimicking ST segment changes in ischemic heart disease. J Vet Med Sci 2015; 78:313-6. [PMID: 26346747 PMCID: PMC4785125 DOI: 10.1292/jvms.15-0440] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To mimic ischemic heart disease in humans, several animal models have been created, mainly in rodents by
surgically ligating their coronary arteries. In the present study, by simply inducing burn injuries on the
bullfrog heart, we reproduced abnormal ST segment changes in the electrocardiogram (ECG), mimicking those
observed in ischemic heart disease, such as acute myocardial infarction and angina pectoris. The “currents of
injury” created by a voltage gradient between the intact and damaged areas of the myocardium, negatively
deflected the ECG vector during the diastolic phase, making the ST segment appear elevated during the systolic
phase. This frog model of heart injury would be suitable to explain the mechanisms of ST segment changes
observed in ischemic heart disease.
Collapse
Affiliation(s)
- Itsuro Kazama
- Department of Physiology I, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| |
Collapse
|
34
|
Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis. PLoS One 2015; 10:e0136174. [PMID: 26284799 PMCID: PMC4540436 DOI: 10.1371/journal.pone.0136174] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 07/31/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A number of studies have assessed the predictive effect of QRS-T angles in various populations since the last decade. The objective of this meta-analysis was to evaluate the prognostic value of spatial/frontal QRS-T angle on all-cause death and cardiac death. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from their inception until June 5, 2014. Studies reporting the predictive effect of spatial/frontal QRS-T angle on all-cause/cardiac death in all populations were included. Relative risk (RR) was used as a measure of effect. RESULTS Twenty-two studies enrolling 164,171 individuals were included. In the combined analysis in all populations, a wide spatial QRS-T angle was associated with an increase in all-cause death (maximum-adjusted RR: 1.40; 95% confidence interval [CI]: 1.32 to 1.48) and cardiac death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90), a wide frontal QRS-T angle also predicted a higher rate of all-cause death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90). Largely similar results were found using different methods of categorizing for QRS-T angles, and similar in subgroup populations such as general population, populations with suspected coronary heart disease or heart failure. Other stratified analyses and meta-analyses using unadjusted data also generated consistent findings. CONCLUSIONS Spatial QRS-T angle held promising prognostic value on all-cause death and cardiac death. Frontal QRS-T angle was also a promising predictor of all-cause death. Given the good predictive value of QRS-T angle, a combined stratification strategy in which QRS-T angle is of vital importance might be expected.
Collapse
|
35
|
Abstract
Arrhythmic sudden cardiac death (SCD) may be caused by ventricular tachycardia/fibrillation or pulseless electric activity/asystole. Effective risk stratification to identify patients at risk of arrhythmic SCD is essential for targeting our healthcare and research resources to tackle this important public health issue. Although our understanding of SCD because of pulseless electric activity/asystole is growing, the overwhelming majority of research in risk stratification has focused on SCD-ventricular tachycardia/ventricular fibrillation. This review focuses on existing and novel risk stratification tools for SCD-ventricular tachycardia/ventricular fibrillation. For patients with left ventricular dysfunction or myocardial infarction, advances in imaging, measures of cardiac autonomic function, and measures of repolarization have shown considerable promise in refining risk. Yet the majority of SCD-ventricular tachycardia/ventricular fibrillation occurs in patients without known cardiac disease. Biomarkers and novel imaging techniques may provide further risk stratification in the general population beyond traditional risk stratification for coronary artery disease alone. Despite these advances, significant challenges in risk stratification remain that must be overcome before a meaningful impact on SCD can be realized.
Collapse
Affiliation(s)
- Marc W Deyell
- From Heart Rhythm Services, the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada (M.W.D., A.D.K.); and Center for Cardiovascular Innovation and the Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (J.J.G.)
| | - Andrew D Krahn
- From Heart Rhythm Services, the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada (M.W.D., A.D.K.); and Center for Cardiovascular Innovation and the Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (J.J.G.)
| | - Jeffrey J Goldberger
- From Heart Rhythm Services, the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada (M.W.D., A.D.K.); and Center for Cardiovascular Innovation and the Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (J.J.G.).
| |
Collapse
|
36
|
Watanabe E, Abbasi SA, Heydari B, Coelho-Filho OR, Shah R, Neilan TG, Murthy VL, Mongeon FP, Barbhaiya C, Jerosch-Herold M, Blankstein R, Hatabu H, van der Geest RJ, Stevenson WG, Kwong RY. Infarct tissue heterogeneity by contrast-enhanced magnetic resonance imaging is a novel predictor of mortality in patients with chronic coronary artery disease and left ventricular dysfunction. Circ Cardiovasc Imaging 2014; 7:887-894. [PMID: 25287527 DOI: 10.1161/circimaging.113.001293] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Strategies for prevention of sudden cardiac death focus on severe left ventricular (LV) dysfunction, although most sudden cardiac death postmyocardial infarction occurs in patients with mild/moderate LV dysfunction. We tested the hypothesis that infarct heterogeneity by cardiac magnetic resonance is associated with mortality beyond LV ejection fraction (LVEF) in patients with coronary artery disease and LV dysfunction. In addition, we examined the association between infarct heterogeneity and mortality in those with LVEF >35%. METHODS AND RESULTS We studied 301 patients with coronary artery disease and LV dysfunction referred for cardiac magnetic resonance. We quantified total infarct mass, infarct core mass, and peri-infarct zone (PIZ) normalized for total infarct mass (%PIZ) using signal-intensity criteria of >2 SDs, >3 SDs, and 2- to -3 SDs above remote myocardium, respectively. Mean LVEF was 41 ± 14%. After 3.9 years median follow-up, 66 (22%) patients died (13 sudden cardiac death; 33 with LVEF >35%). In patients with LVEF >35%, below-median %PIZ carried an annual death rate of 2.8% versus 12% in patients with above-median %PIZ (P<0.001). In a multivariable model, %PIZ maintained strong association with mortality adjusted to patient age, LVEF, right ventricular ejection fraction, prolonged QT interval, and total infarct size and resulted in improve risk reclassification 0.492 (95% confidence interval, 0.183-0.817). CONCLUSIONS Cardiac magnetic resonance infarct heterogeneity has a strong association with mortality independent of LVEF in patients with coronary artery disease and LV dysfunction, particularly in patients with mild or moderate LV dysfunction. Further studies incorporating cardiac magnetic resonance in clinical decision making for defibrillator therapy are warranted.
Collapse
Affiliation(s)
- Eri Watanabe
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Siddique A Abbasi
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Bobak Heydari
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Otavio R Coelho-Filho
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Ravi Shah
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Tomas G Neilan
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Venkatesh L Murthy
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - François-Pierre Mongeon
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Chirag Barbhaiya
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Michael Jerosch-Herold
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Ron Blankstein
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Hiroto Hatabu
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Robert J van der Geest
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - William G Stevenson
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| | - Raymond Y Kwong
- Section of Noninvasive Cardiovascular Imaging (E.W., S.A.A., B.H., O.R.C.-F., R.S., T.G.N., V.L.M., F.-P.M., R.B., R.Y.K.), Cardiovascular Division, Department of Medicine (C.B., R.B., W.G.S., R.Y.K.), and Department of Radiology (M.J.-H., H.H.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands (R.J.v.d.G.)
| |
Collapse
|
37
|
Udink ten Cate FE, Sreeram N, Brockmeier K. The pathophysiologic aspects and clinical implications of electrocardiographic parameters of ventricular conduction delay in repaired tetralogy of Fallot. J Electrocardiol 2014; 47:618-24. [DOI: 10.1016/j.jelectrocard.2014.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Indexed: 11/25/2022]
|
38
|
Thakkar JB, Zaman S, Byth K, Narayan A, Thiagalingam A, Chow C, Thomas SP, Sivagangabalan G, Farlow D, Barnett R, Kovoor P. Right ventricular dysfunction predisposes to inducible ventricular tachycardia at electrophysiology studies in patients with acute ST-segment-elevation myocardial infarction and reduced left ventricular ejection fraction. Circ Arrhythm Electrophysiol 2014; 7:898-905. [PMID: 25108742 DOI: 10.1161/circep.113.001594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inducible ventricular tachycardia (VT) is a strong predictor of spontaneous ventricular tachyarrhythmia following ST-segment-elevation myocardial infarction. Reduced left ventricular ejection fraction (EF) predisposes patients to inducible VT after ST-segment-elevation myocardial infarction. However, the role of right ventricular (RV) dysfunction in predisposing to inducible VT has not been described previously. METHODS AND RESULTS Consecutive patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention underwent predischarge radionuclide gated heart pool scan to assess ventricular EF. The study cohort included patients with reduced left ventricular EF (left ventricular EF ≤40%) who underwent electrophysiology study (n=220) in an attempt to induce VT. We defined RV dysfunction as RVEF ≤35%. The end point was sustained monomorphic VT (cycle length ≥200 ms). This was considered a positive study. No inducible arrhythmia, ventricular fibrillation, or flutter (cycle length <200 ms) was considered a negative study. Infarct region, infarct-related artery, male sex, and RVEF ≤35% were univariable predictors of positive test. After multivariable analysis, RVEF ≤35% had the strongest association as an independent predictor of inducible VT at electrophysiology study (P<0.001; odds ratio, 5.8; 95% confidence interval, 3.005-11.262). CONCLUSIONS RV dysfunction (RVEF ≤35%) predisposed to inducible VT at electrophysiology study in patients with impaired left ventricular EF (≤40%) after acute ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention.
Collapse
Affiliation(s)
- Jay B Thakkar
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Sarah Zaman
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Karen Byth
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Arun Narayan
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Aravinda Thiagalingam
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Clara Chow
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Stuart P Thomas
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Gopal Sivagangabalan
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - David Farlow
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Robert Barnett
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.)
| | - Pramesh Kovoor
- From the Westmead Hospital, Westmead, Australia (J.B.T., S.Z., K.B., A.N., A.T., C.C., S.P.T., G.S., D.F., R.B., P.K.) and Sydney Medical School, University of Sydney, Sydney, Australia (J.B.T., A.T., C.C., S.P.T., G.S., P.K.).
| |
Collapse
|
39
|
Goldberger JJ, Basu A, Boineau R, Buxton AE, Cain ME, Canty JM, Chen PS, Chugh SS, Costantini O, Exner DV, Kadish AH, Lee B, Lloyd-Jones D, Moss AJ, Myerburg RJ, Olgin JE, Passman R, Stevenson WG, Tomaselli GF, Zareba W, Zipes DP, Zoloth L. Risk stratification for sudden cardiac death: a plan for the future. Circulation 2014; 129:516-26. [PMID: 24470473 DOI: 10.1161/circulationaha.113.007149] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jeffrey J Goldberger
- Department of Medicine-Cardiology (J.J.G., A.H.K., R.P.), Department of Preventive Medicine (D.L.-J., R.P.), and Weinberg College of Arts and Sciences and Medical Humanities and Bioethics (L.Z.), Northwestern University, Chicago, IL; Department of Health Services and Pharmacy, University of Washington, Seattle (A.B.); National Institutes of Health, Washington DC (R.B.); Cardiovascular Institute, Beth Israel Deaconess Medical Center, Boston, MA (A.E.B.); Department of Medicine, University at Buffalo, The State University of New York, Buffalo (M.E.C., J.M.C.); Krannert Institute of Cardiology, Indiana University, Indianapolis (P.-S.C., D.P.Z.); Cardiac Electrophysiology Research, Cedars-Sinai Medical Center, Los Angeles, CA (S.S.C.); Summa Health System Cardiovascular Institute, Cleveland, OH (O.C.); CON-ECT Clinical Coordinating Centre, Calgary, Alberta, Canada (D.V.E.); Department of Medicine, University of California, San Francisco (B.L., J.E.O.); Department of Medicine (A.J.M.), and Department of Medicine Cardiology (W.Z.), University of Rochester Medical Center, Rochester, NY; Department of Medicine, University of Miami Health System, Miami, FL (R.J.M.); Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (W.G.S.); and Department of Medicine, The Johns Hopkins University Baltimore, MD (G.F.T.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Sudden Cardiac Death Risk Stratification in Patients With Nonischemic Dilated Cardiomyopathy. J Am Coll Cardiol 2014; 63:1879-89. [DOI: 10.1016/j.jacc.2013.12.021] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 11/16/2013] [Accepted: 12/03/2013] [Indexed: 11/16/2022]
|
41
|
Gao G, Brahmanandam V, Raicu M, Gu L, Zhou L, Kasturirangan S, Shah A, Negi SI, Wood MR, Desai AA, Tatooles A, Schwartz A, Dudley SC. Enhanced risk profiling of implanted defibrillator shocks with circulating SCN5A mRNA splicing variants: a pilot trial. J Am Coll Cardiol 2014; 63:2261-9. [PMID: 24703920 DOI: 10.1016/j.jacc.2014.02.588] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/26/2014] [Accepted: 02/04/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine the association of SCN5A cardiac sodium (Na(+)) channel mRNA splice variants in white blood cells (WBCs) with risk of arrhythmias in heart failure (HF). BACKGROUND HF is associated with upregulation of two cardiac SCN5A mRNA splice variants that encode prematurely truncated, nonfunctional Na(+) channels. Because circulating WBCs demonstrate similar SCN5A splicing patterns, we hypothesized that these WBC-derived splice variants might further stratify patients with HF who are at risk for arrhythmias. METHODS Simultaneously obtained myocardial core samples and WBCs were compared for SCN5A variants C (VC) and D (VD). Circulating variant levels were compared among patients with HF, divided into three groups: HF without an implantable cardioverter-defibrillator (ICD), HF with an ICD without appropriate intervention, and HF with an ICD with appropriate intervention. RESULTS Myocardial tissue-derived SCN5A variant expression levels strongly correlated with circulating WBC samples for both VC and VD variants (r = 0.78 and 0.75, respectively). After controlling for covariates, patients with HF who had received an appropriate ICD intervention had higher expression levels of both WBC-derived SCN5A variants compared with patients with HF with ICDs who had not received appropriate ICD intervention (odds ratio, 3.25; 95% CI, 1.64-6.45; p = 0.001). Receiver operating characteristic analysis revealed that circulating SCN5A variant levels were highly associated with the risk for appropriate ICD intervention (area under the curve ≥0.97). CONCLUSIONS Circulating expression levels of SCN5A variants were strongly associated with myocardial tissue levels. Furthermore, circulating variant levels were correlative with arrhythmic risk as measured by ICD events in an HF population within 1 year. (Sodium Channel Splicing in Heart Failure Trial [SOCS-HEFT]; NCT01185587).
Collapse
Affiliation(s)
- Ge Gao
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois
| | - Vikram Brahmanandam
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois
| | - Mihai Raicu
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois
| | - Lianzhi Gu
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois
| | - Li Zhou
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois
| | - Srinivasan Kasturirangan
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois
| | - Anish Shah
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Smita I Negi
- The University of Texas Health Science Center, Houston, Texas
| | - Melissa R Wood
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois
| | - Ankit A Desai
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois; Institute for Personalized Respiratory Medicine and Center for Cardiovascular Research, University of Illinois at Chicago, Chicago, Illinois
| | - Antone Tatooles
- Transplant/Mechanical Assist, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Samuel C Dudley
- Section of Cardiology and the Jesse Brown VAMC, University of Illinois at Chicago, Chicago, Illinois.
| |
Collapse
|
42
|
Nasario-Junior O, Benchimol-Barbosa PR, Nadal J. Principal component analysis in high resolution electrocardiogram for risk stratification of sustained monomorphic ventricular tachycardia. Biomed Signal Process Control 2014. [DOI: 10.1016/j.bspc.2013.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
43
|
Wickenbrock I, Perings C. [Ventricular tachycardia in postinfarction patients and coronary heart disease. Treatment and prognostic significance]. Herzschrittmacherther Elektrophysiol 2014; 25:47-52. [PMID: 24458339 DOI: 10.1007/s00399-013-0297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 11/29/2022]
Abstract
Patients with coronary heart disease are subject to an increased risk for sudden cardiac death (SCD). Within the first 30-90 days after the myocardial infarct the risk is particularly high. In times of implantable cardioverter-defibrillator (ICD) on the one hand and the ability to bridge high-risk periods with e. g. wearable defibrillator vests on the other, adequate risk stratification is essential. Currently, the main parameter for this is the left ventricular ejection fraction (LVEF). However, risk stratification by measurement of the LVEF has severe limitations, especially since the majority of patients suffering from SCD have a normal LVEF. Various other methods like ventricular ectopy, signal-averaged ECG, QRS width, microvolt T-wave alternans and programmed ventricular stimulation have been previously evaluated. None of these methods alone or in combination with a left ventricular function assessment was capable of improving the predictability of arrhythmic events significantly. Considering the multiple mechanisms that can lead to SCD, a single risk stratifier seems unrealistic. However, patients with chronic total occlusion of a coronary artery and residual or provocable ischemia have an increased risk for SCD. Therefore a combination of clinical and angiographic parameters seems reasonable. Advanced echocardiographic parameters e.g. mechanical dispersion could be used on a complementary role.
Collapse
Affiliation(s)
- Ingo Wickenbrock
- Medizinische Klinik I, Abteilung für Kardiologie, Elektrophysiologie, Pneumologie und konservative Intensivmedizin, Klinikum Lünen, Altstadtstr. 23, 44532, Lünen, Deutschland,
| | | |
Collapse
|
44
|
Apiyasawat S, Sahasthas D, Ngarmukos T, Chandanamattha P, Likittanasombat K. Fragmented QRS as a Predictor of Appropriate Implantable Cardioverter-defibrillator Therapy. Indian Pacing Electrophysiol J 2014; 14:4-11. [PMID: 24493911 PMCID: PMC3878583 DOI: 10.1016/s0972-6292(16)30710-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Fragmented QRS (fQRS) has been shown to be a marker of local myocardial conduction abnormalities and a predictor of cardiac events in selected populations. We hypothesized that the presence of a fQRS might predict arrhythmic events in patients who received an implantable cardioverter-defibrillator (ICD), regardless of the indications for implantation. Methods and Results A cohort of 107 consecutive patients (mean age, 53 years; 82% male) who underwent an ICD implantation was studied. We defined fQRS, on a routine 12-lead ECG, as the presence of an additional R wave or notching in the nadir of the S wave in 2 consecutive leads corresponding to a major coronary artery territory. In the presence of bundle branch block, more than 2 notches in the R or S waves in 2 consecutive leads were required to characterize fQRS. Patients were followed for 21.3±23 months for appropriate ICD therapy (antitachycardia pacing and/or shock). ICDs were implanted predominantly in patients with ischemic cardiomyopathy (N=45, 42.1%), followed by Brugada syndrome (N=26, 24.3%). fQRS presented in 42 patients (39.3%). During follow-up, patients with fQRS received more appropriate ICD therapy than those without fQRS (45.2% vs. 10.8%, P<0.0001). After adjustment for covariates, fQRS remained an independent predictor for appropriate ICD therapy (hazard ratio=5.32, 95% confidence interval=2.11-13.37, P<0.0001). Conclusion The presence of fQRS appeared to be directly associated with appropriate ICD therapy.
Collapse
|
45
|
Poulikakos D, Banerjee D, Malik M. Major arrhythmic events and T wave morphology descriptors in hemodialyzed patients. J Electrocardiol 2013; 47:240-3. [PMID: 24360879 DOI: 10.1016/j.jelectrocard.2013.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sudden cardiac death is common in patients receiving regular hemodialysis (HD). We recently demonstrated that selected repolarization descriptors calculated from electrocardiographic monitoring during HD demonstrate intra-subject stability. In this study we followed up the initial cohort for major arrhythmic events (MAE). METHODS Holter electrocardiograms (ECGs) were recorded during dialysis in 81 HD patients and repeated 5 times at 2 week intervals. The QRS-to-T angle (TCRT), the principal component analysis (PCA) ratio and the T wave morphology dispersion (TMD) were calculated in overlapping 10 second ECG segments and averaged overall recordings in each patient. Patients were followed up for MAE and non-arrhythmic mortality. RESULTS During 18 ± 3 months, 3 patients experienced MAE. Compared to others, MAE patients exhibited extreme TCRT and TMD values and minimal intradialytic changes. CONCLUSION The prognostic value of repolarization descriptors from intradialytic monitoring should be assessed prospectively.
Collapse
Affiliation(s)
- Dimitrios Poulikakos
- Renal and Transplantation Unit, St. George's, University of London, London, United Kingdom; Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
| | - Debasish Banerjee
- Renal and Transplantation Unit, St. George's, University of London, London, United Kingdom; Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom
| | - Marek Malik
- Imperial College of Science Technology and Medicine, London, United Kingdom
| |
Collapse
|
46
|
Zaman S, Kumar S, Sullivan J, Narayan A, Thiagalingam A, Ross DL, Kovoor P. Significance of Inducible Very Fast Ventricular Tachycardia (Cycle Length 200–230 ms) After Early Reperfusion for ST-Segment–Elevation Myocardial Infarction. Circ Arrhythm Electrophysiol 2013; 6:884-90. [DOI: 10.1161/circep.113.000213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah Zaman
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Saurabh Kumar
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Janice Sullivan
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Arun Narayan
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Aravinda Thiagalingam
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - David L. Ross
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| | - Pramesh Kovoor
- From the Department of Cardiology, Westmead Hospital, Sydney, Australia (S.Z., J.S., A.N., A.T., D.L.R., P.K.); Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia (S.K.); and Department of Medicine, University of Sydney, Sydney, Australia (S.Z., P.K.)
| |
Collapse
|
47
|
Dagres N, Hindricks G. Risk stratification after myocardial infarction: is left ventricular ejection fraction enough to prevent sudden cardiac death? Eur Heart J 2013; 34:1964-71. [PMID: 23644180 DOI: 10.1093/eurheartj/eht109] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Patients who have experienced a myocardial infarction (MI) are at increased risk of sudden cardiac death (SCD). With the advent of implantable cardioverter-defibrillators (ICDs), accurate risk stratification has become very relevant. Numerous investigations have proven that a reduced left ventricular ejection fraction (LVEF) significantly increases the SCD risk. Furthermore, ICD implantation in patients with reduced LVEF confers significant survival benefit. As a result, LVEF is the cornerstone of current decision making for prophylactic ICD implantation after MI. However, LVEF as standalone risk stratifier has major limitations: (i) the majority of SCD cases occur in patients with preserved or moderately reduced LVEF, (ii) only relatively few patients with reduced LVEF will benefit from an ICD (most will never experience a threatening arrhythmic event, others have a high risk for non-sudden death), (iii) a reduced LVEF is a risk factor for both sudden and non-sudden death. Several other non-invasive and invasive risk stratifiers, such as ventricular ectopy, QRS duration, signal-averaged electrocardiogram, microvolt T-wave alternans, markers of autonomic tone as well as programmed ventricular stimulation, have been evaluated. However, none of these techniques has unequivocally demonstrated the efficacy when applied alone or in combination with LVEF. Apart from their limited sensitivity, most of them are risk factors for both sudden and non-sudden death. Considering the multiple mechanisms involved in SCD, it seems unlikely that a single test will prove adequate for all patients. A combination of clinical characteristics with selected stratification tools may significantly improve risk stratification in the future.
Collapse
Affiliation(s)
- Nikolaos Dagres
- Second Department of Cardiology, University of Athens, Attikon University Hospital, Athens, Greece
| | | |
Collapse
|
48
|
Scott PA, Rosengarten JA, Curzen NP, Morgan JM. Late gadolinium enhancement cardiac magnetic resonance imaging for the prediction of ventricular tachyarrhythmic events: a meta-analysis. Eur J Heart Fail 2013; 15:1019-27. [PMID: 23558217 DOI: 10.1093/eurjhf/hft053] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Approaches to the risk stratification for sudden cardiac death (SCD) remain unsatisfactory. Although late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) for SCD risk stratification has been evaluated in several studies, small sample size has limited their clinical validity. We performed this meta-analysis to better gauge the predictive accuracy of LGE-CMR for SCD risk stratification. METHODS AND RESULTS Electronic databases and published bibliographies were systematically searched to identify studies evaluating the association between the extent of LV scar on LGE-CMR and ventricular arrhythmic events [SCD, resuscitated cardiac arrest, the occurrence of ventricular arrhythmias, or appropriate implantable cardioverter defibrillator (ICD) therapy]. Only studies enrolling patients with CAD or non-ischaemic cardiomyopathy were included. Summary estimates of the relative risk (RR) and likelihood ratios (LRs) were calculated using random effects models. Eleven studies comprising 1105 patients were identified. During a mean/median follow-up of 8.5-41 months 207 patients had ventricular arrhythmic events. Ventricular arrhythmic events were more common in patients with a greater extent of LV scar: RR 4.33 [95% confidence interval (CI) 2.98-6.29], positive LR 1.98 (95% CI 1.66-2.37), and negative LR 0.33 (95% CI 0.24-0.46). CONCLUSION The extent of LGE on CMR is strongly associated with the occurrence of ventricular arrhythmias in patients with reduced LVEF and may be a valuable risk stratification tool for identifying patients who will benefit from ICD therapy. However, uncertainties regarding clinical application persist and need to be addressed prior to introduction into broad clinical practice.
Collapse
Affiliation(s)
- Paul A Scott
- Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, UK.
| | | | | | | |
Collapse
|
49
|
SCOTT PAULA, ROSENGARTEN JAMESA, MURDAY DAVIDC, PEEBLES CHARLESR, HARDEN STEPHENP, CURZEN NICKP, MORGAN JOHNM. Left Ventricular Scar Burden Specifies the Potential for Ventricular Arrhythmogenesis: An LGE-CMR Study. J Cardiovasc Electrophysiol 2012; 24:430-6. [DOI: 10.1111/jce.12035] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
50
|
Laukkanen JA, Jennings JR, Kauhanen J, Mäkikallio TH, Ronkainen K, Kurl S. Relation of systemic blood pressure to sudden cardiac death. Am J Cardiol 2012; 110:378-82. [PMID: 22521306 DOI: 10.1016/j.amjcard.2012.03.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 11/18/2022]
Abstract
The role of systolic blood pressure (SBP) as an independent risk factor for sudden cardiac death (SCD) is not well defined in a general population. Thus, we assessed the association between BP at rest and risk of SCD. BP and other risk factors were measured in a representative population-based sample of 2,666 Finnish men (42 to 61 years of age). During an average follow-up period of 18.9 years (interquartile range 17.9 to 22.6), 213 SCDs occurred. Each increment 10-mm Hg of SBP at rest was associated with an increased risk of SCD (relative hazard 1.15, 95% confidence interval 1.07 to 1.25, p <0.001) after adjustment for age, alcohol consumption, cigarette smoking, serum low-density lipoprotein cholesterol, type 2 diabetes, body mass index, left ventricular hypertrophy, previous myocardial infarction, family history of coronary heart disease, and use of antihypertensive medications. Men with increased SBP of >145 mm Hg had a 2.04-fold (95% confidence interval 1.23 to 2.52, p = 0.003) adjusted risk for SCD compared to those with SBP <123 mm Hg. In conclusion, this study emphasizes the importance of the definition of SBP at rest because it provides a valuable prognostic measurement for SCD.
Collapse
Affiliation(s)
- Jari Antero Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | | | | | | | | | | |
Collapse
|