Τίτλος:
Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: The PRESERVE EF study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Aims: Sudden cardiac death (SCD) annual incidence is 0.6-1% in post-myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF)≥40%. No recommendations for implantable cardioverter-defibrillator (ICD) use exist in this population. Methods and results: We introduced a combined non-invasive/invasive risk stratification approach in post-MI ischaemia-free patients, with LVEF ≥ 40%, in a multicentre, prospective, observational cohort study. Patients with at least one positive electrocardiographic non-invasive risk factor (NIRF): premature ventricular complexes, non-sustained ventricular tachycardia, late potentials, prolonged QTc, increased T-wave alternans, reduced heart rate variability, abnormal deceleration capacity with abnormal turbulence, were referred for programmed ventricular stimulation (PVS), with ICDs offered to those inducible. The primary endpoint was the occurrence of a major arrhythmic event (MAE), namely sustained ventricular tachycardia/fibrillation, appropriate ICD activation or SCD. We screened and included 575 consecutive patients (mean age 57 years, LVEF 50.8%). Of them, 204 (35.5%) had at least one positive NIRF. Forty-one of 152 patients undergoing PVS (27-7.1% of total sample) were inducible. Thirty-seven (90.2%) of them received an ICD. Mean follow-up was 32 months and no SCDs were observed, while 9 ICDs (1.57% of total screened population) were appropriately activated. None patient without NIRFs or with NIRFs but negative PVS met the primary endpoint. The algorithm yielded the following: sensitivity 100%, specificity 93.8%, positive predictive value 22%, and negative predictive value 100%. Conclusion: The two-step approach of the PRESERVE EF study detects a subpopulation of post-MI patients with preserved LVEF at risk for MAEs that can be effectively addressed with an ICD. Clinicaltrials.gov identifier: NCT02124018 © 2019 The Author(s).
Συγγραφείς:
Gatzoulis, K.A.
Tsiachris, D.
Arsenos, P.
Antoniou, C.-K.
Dilaveris, P.
Sideris, S.
Kanoupakis, E.
Simantirakis, E.
Korantzopoulos, P.
Goudevenos, I.
Flevari, P.
Iliodromitis, E.
Sideris, A.
Vassilikos, V.
Fragakis, N.
Trachanas, K.
Vernardos, M.
Konstantinou, I.
Tsimos, K.
Xenogiannis, I.
Vlachos, K.
Saplaouras, A.
Triantafyllou, K.
Kallikazaros, I.
Tousoulis, D.
Περιοδικό:
EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY
Εκδότης:
Oxford University Press
Λέξεις-κλειδιά:
adult; algorithm; Article; cardiovascular risk; cohort analysis; controlled study; electrocardiography; female; follow up; heart arrhythmia; heart failure with preserved ejection fraction; heart infarction; heart left ventricle ejection fraction; heart rate turbulence; heart rate variability; heart stimulation; heart ventricle extrasystole; heart ventricle fibrillation; heart ventricle tachycardia; high risk patient; human; hyperkalemia; invasive procedure; major clinical study; male; middle aged; New York Heart Association class; non invasive procedure; observational study; patient identification; predictive value; priority journal; QT prolongation; risk assessment; risk benefit analysis; risk factor; screening; sensitivity and specificity; stress; sudden cardiac death; sustained ventricular tachycardia; T wave; T wave alternans; aged; ambulatory monitoring; clinical trial; complication; coronary artery bypass graft; heart arrhythmia; heart infarction; heart pacing; heart stroke volume; heart ventricle fibrillation; heart ventricle tachycardia; implantable cardioverter defibrillator; multicenter study; pathophysiology; physiology; prospective study; risk assessment; sudden cardiac death, Adult; Aged; Arrhythmias, Cardiac; Cardiac Pacing, Artificial; Cohort Studies; Coronary Artery Bypass; Death, Sudden, Cardiac; Defibrillators, Implantable; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Monitoring, Ambulatory; Myocardial Infarction; Prospective Studies; Risk Assessment; Stroke Volume; Tachycardia, Ventricular; Ventricular Fibrillation
DOI:
10.1093/eurheartj/ehz260
