Investigator-reported ventricular arrhythmias and mortality in heart failure with mildly reduced or preserved ejection fraction.

Autor:	Curtain JP; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, United Kingdom., Adamson C; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, United Kingdom., Kondo T; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, United Kingdom., Butt JH; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, United Kingdom., Desai AS; Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA., Zannad F; Centre d'Investigations Cliniques Pluithématique 1433 and Inserm U116, CHRU, FCRIN INICRCT (Cardiovascular and Renal Trialists), Université de Lorraine, 5 rue du Morvan 54500 Vandoeuvre-Les-Nancy, France., Rouleau JL; Institut de Cardiologie de Montréal, Université de Montréal, 5000, Bélanger street, Montreal, H1T 1C8, Canada., Rohde LE; Cardiovascular Division, Hospital Moinhos de Vento and Hospital de Clinicas de Porto Alegre, Medical School, UFRGS, Rua Ramiro Barcelos, 2400, Porto Alegre, RS 90.035-003, Brazil., Kober L; Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark., Anand IS; Department of Cardiovascular Medicine, University of Minnesota, 401 East River Parkway, VCRC 1st Floor, Suite 131, Minneapolis, MN 55455, USA., van Veldhuisen DJ; Department of Cardiology, University Medical Center Groningen, University of Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands., Zile MR; Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, 109 Bee St, Charleston, SC 29401, USA., Lefkowitz MP; Novartis, 1 Health Plaza, East Hanover, NJ 07936, USA., Solomon SD; Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA., Packer M; Baylor Heart and Vascular Institute, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA., Petrie MC; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, United Kingdom., Jhund PS; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, United Kingdom., McMurray JJV; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, United Kingdom.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2023 Feb 21; Vol. 44 (8), pp. 668-677.
DOI:	10.1093/eurheartj/ehac801
Abstrakt:	Aims: Few reports have examined the incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) or their relationship with mortality in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF). Methods and Results: Data from the PARAGON-HF, TOPCAT, I-Preserve, and CHARM-Preserved trials were merged. VT/VF, reported as adverse events, were identified. Patients who experienced VT/VF were compared with patients who did not. The relationship between VT/VF and mortality was examined in time-updated Cox proportional hazard regression models. Variables associated with VT/VF were examined in Cox proportional hazard regression models. The rate of VT/VF in patients with HFmrEF compared with patients with HFpEF was examined in a Cox proportional hazards regression model. Of 13 609 patients, over a median follow-up of 1170 days (interquartile range: 966-1451), 146 (1.1%) experienced an investigator-reported VT/VF (incidence rate 0.3 per 100 person-years). Patients who experienced VT/VF were more likely to be male, have had a myocardial infarction, poorer renal function, more adverse left ventricular remodelling, and higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) than patients who did not. Occurrence of VT/VF was associated with NT-proBNP, history of atrial fibrillation/flutter, male sex, lower ejection fraction, and history of hypertension. VT/VF was associated with all-cause death [adjusted hazard ratio (HR): 3.95, 95% confidence interval (CI): 2.80-5.57; P < 0.001] and cardiovascular death, driven by death from heart failure and not sudden death. Patients with HFmrEF had a higher rate of VT/VF than patients with HFpEF (adjusted HR: 2.19, 95% CI: 1.77-2.71). Conclusion: VT/VF was uncommon in patients with HFmrEF and HFpEF. However, such events were strongly associated with mortality and appear to be a marker of disease severity rather than risk of sudden death. Clinical Trial Registration: ClinicalTrials.gov unique identifier: NCT01920711(PARAGON-HF); NCT00094302 (TOPCAT); NCT00095238 (I-Preserve); NCT00634712 (CHARM-Preserved). Competing Interests: Conflicts of interest: F.Z. reports personal fees from Boerhinger Ingelheim, Janssen, Novartis, Boston Scientific, Amgen, CVRx, AstraZeneca, Vifor Fresenius, Cardior, Cereno pharmaceutical, Applied Therapeutics, Merck, Bayer, and Cellprothera. J.L.R. reports grants and consulting fees from Novartis and consulting fees from AstraZeneca. M.P. has received consulting fees from Abbvie, Amgen, Amarin, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Casana, CSL Behring, Cytokinetics, Johnson & Johnson, Lilly, Moderna, Novartis, ParatusRx, Pfizer, Relypsa, Salamandra, Synthetic Biologics, and Theravance; has received payment for expert testimony from Actavis; and has received support for attending meetings and/or travel from Boehringer Ingelheim. I.S.A. has received fees for serving on a steering committee from ARCA Biopharma, Amgen, LivaNova, and Novartis; fees for serving on an end point committee from Boehringer Ingelheim; and fees for serving as chair of a data and safety monitoring board from Boston Scientific. M.R.Z. has received grants, consulting fees, and participation on a data safety monitoring board or advisory board as part of the committees for the PARAGON-HF and PARADIGM-HF trials. A.S.D. received institutional research grant support from Abbott, AstraZeneca, Alnylam, Bayer and Novartis; and has received personal consulting fees from Abbott, Alnylam, Amgem, AstraZeneca, Biofourmis, Boerhinger Ingelheim, Boston Scientific Cytokinetics, DalCor Pharma, Lupin Pharma, Lexicon, Merck, Novartis, Relypsa, Regeneron, and Sun Pharma. M.P.L. is an employee of Novartis. T.K. received lecture fees from Abbott Medical Japan LLC, Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Novartis Pharma K.K., AstraZeneca K.K., Bristol Myers Squibb Co., and Abiomed Japan K.K. L.K. has received speakers honorarium from Novo, Novartis, AstraZeneca, Boehringer Ingelheim and Bayer. L.E.R. has been a consultant or served on advisory boards for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Merck, Novartis and Pfizer. J.B. has received advisory board honoraria from Bayer. M.C.P. reports compensation from Bayer for end point committee services; compensation from Boehringer Ingelheim for end point committee services; compensation from AstraZeneca for consultant services; compensation from Novo Nordisk for consultant services; compensation from Takeda California Inc for end point review committee services; grants from Boehringer Ingelheim; compensation from Novo Nordisk for end point review committee services; compensation from Novartis for consultant services; grants from Novartis to other; grants from SQ Innovation to other; compensation from SQ Innovation for consultant services; and grants from AstraZeneca to other. P.S.J. reports speakers and advisory board fees from AstraZeneca, Boehringer Ingelheim and Novartis; and reports research funding from Boehringer Ingelheim and Analog Devices. S.D.S. received grants to his institution from Actelion, Alnylam, Amgem, AstraZenaca, Belleerophon, Bayer, Bristol Myers Squibb, Celladon, Cytokinectics, Eidos, Gilead, GlaxoSmithKline, IONIS, Lilly, Mesoblast, MyoKardia, National Institute of Health National Heart, Lung, and Blood Institute, Neurotronik, Novartis, Novo Nordisk, Respicardia, Sanofi Pasteur, Theracos, and US2.AI; received fees for consultancy from Abbott, Action, Akros, Alnylam, Amgem, Arena, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardior, Cardurion, Corvia, Cytokenetics, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, and Sarepta; and received honoraria for lectures from Novartis and AstraZeneca. J.J.V.M. has received personal lecture fees from Abbott, Alkem Metabolics, Eris Lifesciences, Hikma, Lupin, Sun Pharmaceuticals, Medscape/Heart.Org, ProAdWise Communications, Radcliffe Cardiology Servier, and the Corpus; and reports steering committee and travel fees from Amgen, steering committee fees from Bayer, investigator and travel fees from Theracos, consultancy and travel fees from IONIS, steering committee fees from DalCor, investigator, steering committee and travel fees from Novartis, investigator, steering committee and travel fees from GlaxoSmithKline, steering committee fees from Bristol Myers Squibb, consultancy fees from Boehringer Ingelheim, advisory board fees from Cardurion, and advisory board fees from Alnylam all paid to the University of Glasgow. All other authors report no disclosures. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. 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