Bergau, Leonard and Willems, Rik and Sprenkeler, David J. and Fischer, Thomas H. and Flevari, Panayota and Hasenfuss, Gerd and Katsaras, Dimitrios and Kirova, Aleksandra and Lehnart, Stephan E. and Luethje, Lars and Roever, Christian and Seegers, Joachim and Sossalla, Samuel and Dunnink, Albert and Sritharan, Rajevaa and Tuinenburg, Anton E. and Vandenberk, Bert and Vos, Marc A. and Wijers, Sofieke C. and Friede, Tim and Zabel, Markus (2018) Differential multivariable risk prediction of appropriate shock versus competing mortality - A prospective cohort study to estimate benefits from ICD therapy. INTERNATIONAL JOURNAL OF CARDIOLOGY, 272. pp. 102-107. ISSN 0167-5273, 1874-1754
Full text not available from this repository. (Request a copy)Abstract
Background and objective: We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics in a cohort study of ICD patients. Methods: For 672 enrolled patients, we collected history, LVEF, EP study and T-wave altemans testing, 24-h Hotter, IsiT-proBNP, and the eGFR All-cause mortality and first appropriate ICD shock were predefined endpoints. Results: The 635 patients included in the final analyses were 63 +/- 13 years old, 81% were male, LVEF averaged 40 +/- 14%. 20% were inducible at EP study, 63% had a primary prophylactic ICD. During follow-up over 4.3 +/- 15 years, 108 patients died (4.0% per year), and appropriate shock therapy occurred inn - 96 (3.9% per year). In multivariate regression, age (p < 0.001), LVEF (p < 0.001), NYHA functional class (p = 0.007), eGFR (p = 0.024), a history of atrial fibrillation (p = 0.011). and NT-pro-BNP (p = 0.002) were predictors of mortality. LVEF (p = 0.002), inducibility at EP study (p = 0.007). and secondary prophylaxis (p = 0.002) were identified as independent predictors of appropriate shocks. A high annualized risk of shocks of about 10% per year was prevalent in the upper quintile of the shock score. In contrast, a low annual risk of shocks (1.8% per year) was found in the lower two quintiles of the shock score. The lower two quintiles of the mortality score featured an annual mortality <0.6%. Conclusions: In a prospective ICD patient cohort, a very good approximation of mortality versus arrhythmic risk was possible using a multivariable diagnostic strategy. EP stimulation is the best test to assess risk of arrhythmias resulting in ICD shocks. (C) 2018 The Authors. Published by Elsevier B.V.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR; SUDDEN CARDIAC DEATH; T-WAVE ALTERNANS; PROGRAMMED VENTRICULAR STIMULATION; CORONARY-ARTERY-DISEASE; HEART-FAILURE; MYOCARDIAL-INFARCTION; PRIMARY PREVENTION; ISCHEMIC CARDIOMYOPATHY; CLINICAL-PRACTICE; Implantable cardioverter defibrillator; Risk factors; Mortality; Sudden cardiac death |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 04 Oct 2019 10:19 |
| Last Modified: | 04 Oct 2019 10:19 |
| URI: | https://pred.uni-regensburg.de/id/eprint/13445 |
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