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Bencivenga L, Komici K, Paolillo S, Nappi C, Gargiulo P, Assante R, Gambino G, Santillo F, Femminella GD, Corbi GM, Ferrara N, Cuocolo A, Perrone-Filardi P, Rengo G. Cardiac sympathetic innervation and mortality risk scores in patients with heart failure. Eur J Clin Invest 2023; 53:e13948. [PMID: 36576359 DOI: 10.1111/eci.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In the risk stratification and selection of patients with heart failure (HF) eligible for implantable cardioverter-defibrillator (ICD) therapy, 123 I-meta-IodineBenzylGuanidine (123 I-mIBG) scintigraphy has emerged as an effective non-invasive method to assess cardiac adrenergic innervation. Similarly, clinical risk scores have been proposed to identify patients with HF at risk of all-cause mortality, for whom the net clinical benefit of device implantation would presumably be lower. Nevertheless, the association between the two classes of tools, one suggestive of arrhythmic risk, the other of all-cause mortality, needs further investigation. OBJECTIVE To test the relationship between the risk scores for predicting mortality and cardiac sympathetic innervation, assessed through myocardial 123 I-mIBG imaging, in a population of patients with HF. METHODS In HF patients undergoing 123 I-mIBG scintigraphy, eight risk stratification models were assessed: AAACC, FADES, MADIT, MADIT-ICD non-arrhythmic mortality score, PACE, Parkash, SHOCKED and Sjoblom. Cardiac adrenergic impairment was assessed by late heart-to-mediastinum ratio (H/M) <1.6. RESULTS Among 269 patients suffering from HF, late H/M showed significant negative correlation with all the predicting models, although generally weak, ranging from -0.15 (p = .013) for PACE to -0.32 (p < .001) for FADES. The scores showed poor discrimination for cardiac innervation, with areas under the curve (AUC) ranging from 0.546 for Parkash to 0.621 for FADES. CONCLUSION A weak association emerged among mortality risk scores and cardiac innervation, suggesting to integrate in clinical practice tools indicative of both arrhythmic and general mortality risks, when evaluating patients affected by HF eligible for device implantation.
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Affiliation(s)
- Leonardo Bencivenga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.,Gérontopôle de Toulouse, Institut du Vieillissement, CHU de Toulouse, Toulouse, France
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppina Gambino
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Fabio Santillo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | | | - Grazia Maria Corbi
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Perrone-Filardi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit, Telese Terme, Italy
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Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients. Cardiovasc Diabetol 2022; 21:143. [PMID: 35906611 PMCID: PMC9338523 DOI: 10.1186/s12933-022-01580-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy. Methods We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs. Results Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36–1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56–2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35–2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39–0.79). Conclusion Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01580-y.
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Calvi V, Zanotto G, D'Onofrio A, Bisceglia C, Iacopino S, Pignalberi C, Pisanò EC, Solimene F, Giammaria M, Biffi M, Maglia G, Marini M, Senatore G, Pedretti S, Forleo GB, Santobuono VE, Curnis A, Russo AD, Rapacciuolo A, Quartieri F, Bertocchi P, Caravati F, Manzo M, Saporito D, Orsida D, Santamaria M, Bottaro G, Giacopelli D, Gargaro A, Bella PD. One-year mortality after implantable defibrillator implantation: do risk stratification models help improving clinical practice? J Interv Card Electrophysiol 2021; 64:607-619. [PMID: 34709504 DOI: 10.1007/s10840-021-01083-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the available mortality risk stratification models for implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT-D) patients. METHODS We conducted a review of mortality risk stratification models and tested their ability to improve prediction of 1-year survival after implant in a database of patients who received a remotely controlled ICD/CRT-D device during routine care and included in the independent Home Monitoring Expert Alliance registry. RESULTS We identified ten predicting models published in peer-reviewed journals between 2000 and 2021 (Parkash, PACE, MADIT, aCCI, CHA2DS2-VASc quartiles, CIDS, FADES, Sjoblom, AAACC, and MADIT-ICD non-arrhythmic mortality score) that could be tested in our database as based on common demographic, clinical, echocardiographic, electrocardiographic, and laboratory variables. Our cohort included 1,911 patients with left ventricular dysfunction (median age 71, 18.3% female) from sites not using any risk stratification score for systematic patient screening. Patients received an ICD (53.8%) or CRT-D (46.2%) between 2011 and 2017, after standard physician evaluation. There were 56 deaths within 1-year post-implant, with an all-cause mortality rate of 2.9% (95% confidence interval [CI], 2.3-3.8%). Four predicting models (Parkash, MADIT, AAACC, and MADIT-ICD non-arrhythmic mortality score) were significantly associated with increased risk of 1-year mortality with hazard ratios ranging from 3.75 (CI, 1.31-10.7) to 6.53 (CI 1.52-28.0, p ≤ 0.014 for all four). Positive predictive values of 1-year mortality were below 25% for all models. CONCLUSION In our analysis, the models we tested conferred modest incremental predicting power to ordinary screening methods.
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Affiliation(s)
- Valeria Calvi
- Policlinico G. Rodolico, Az. O.U. Policlinico - V. Via S. Sofia 78, 95123, Catania, Emanuele, Italy.
| | | | | | | | | | | | | | | | | | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Stefano Pedretti
- Ospedale Sant'Anna, ASST Lariana, San Fermo della Battaglia, CO, Italy
| | | | | | | | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | | | | | - Michele Manzo
- Azienda Ospedaliera Universitaria S.Giovanni Di Dio E Ruggi D'Aragona, Salerno, Italy
| | | | | | | | - Giuseppe Bottaro
- Policlinico G. Rodolico, Az. O.U. Policlinico - V. Via S. Sofia 78, 95123, Catania, Emanuele, Italy
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Platonov PG, Holmqvist F. Registry data on implantation of ICD is not necessarily reflective of an arrhythmic event. Am Heart J 2019; 212:158-159. [PMID: 30992123 DOI: 10.1016/j.ahj.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden.
| | - Fredrik Holmqvist
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden
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Sjöblom J, Borgquist R, Gadler F, Kalm T, Ljung L, Rosenqvist M, Frykman V, Platonov PG. Clinical risk profile score predicts all cause mortality but not implantable cardioverter defibrillator intervention rate in a large unselected cohort of patients with congestive heart failure. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 27800644 DOI: 10.1111/anec.12414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/28/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Primary prophylactic implantable cardioverter defibrillator (ICD) therapy is indicated for patients with reduced left ventricular ejection fraction (LVEF). We aimed to determine if preoperative clinical risk profiling can predict long-term benefit, and if clinical risk scores can be applied and improved in a patient cohort outside the clinical trial setting. METHODS Using registry data, 789 patients with reduced LVEF who received ICDs for primary prevention during 2006-2011 were identified (age 64 ± 11 years, 82% men, 63% ischemic etiology, 52% cardiac resynchronization therapy with defibrillator). The patients were divided into three risk groups, based on the presence of baseline clinical risk factors (age >70, QRS duration >120 ms, New York Heart Association class III-IV, atrial fibrillation history, or creatinine >106 μmol/L). Endpoints were all-cause mortality and survival free of adequate ICD therapy. RESULTS Mean follow-up was 39 ± 18 months. Annual mortality was 7.6%, and increased with risk group (p < .001). Rates of appropriate antitachycardia pacing and shock therapy were not statistically different between the groups, and ranged from 11%-16% and 6%-14%, respectively. By combining the previous risk score with data on diabetes, a better independent prediction of mortality was achieved; mortality rates then ranged from 11% (low-risk) to 46% (high-risk) (p < .0001). CONCLUSIONS Implantable cardioverter defibrillator therapies occur across the spectrum of comorbidities in a population with systolic heart failure. However, all-cause mortality is considerably higher in the group of patients with accumulated risk factors, and using the proposed scoring system can be helpful for the evaluation and risk stratification of the patient prior to making a decision for a primary prophylactic ICD implantation.
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Affiliation(s)
- Johanna Sjöblom
- Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden
| | - Rasmus Borgquist
- Arrhythmia Clinic, Skåne University Hospital and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Fredrik Gadler
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Kalm
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lina Ljung
- Section of Cardiology, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Mårten Rosenqvist
- Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden
| | - Viveka Frykman
- Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden
| | - Pyotr G Platonov
- Arrhythmia Clinic, Skåne University Hospital and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
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