Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model

Autor: Ramírez, Julia, Orini, Michele, Mincholé, Ana, Monasterio, Violeta, Cygankiewicz, Iwona, Bayés de Luna, Antonio, Martínez, Juan Pablo, Laguna, Pablo, Pueyo, Esther, Universitat Autònoma de Barcelona
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
ACE inhibitors
lcsh:Medicine
Repolarization
030204 cardiovascular system & hematology
Sudden Cardiac Death
Biochemistry
Sudden cardiac death
Electrocardiography
0302 clinical medicine
Endocrinology
Postinfarction patients
Medicine and Health Sciences
030212 general & internal medicine
lcsh:Science
Restitution
Multidisciplinary
Framingham Risk Score
Ejection fraction
medicine.diagnostic_test
Physics
T- Wave alternans
Hazard ratio
Models
Cardiovascular
Classical Mechanics
Drugs
Paciente
Heart
Enzyme inhibitors
Stroke volume
Middle Aged
Dispersion
Prognosis
3. Good health
Bioassays and Physiological Analysis
Physical Sciences
Cardiology
Female
Anatomy
Arrhythmia
Research Article
medicine.medical_specialty
Endocrine Disorders
Rate turbulence
Fluid Mechanics
Epidemology
Research and Analysis Methods
Continuum Mechanics
03 medical and health sciences
Internal medicine
Heart rate
medicine
Diabetes Mellitus
Humans
cardiovascular diseases
Mortality
Aged
Probability
Pharmacology
Heart Failure
business.industry
Electrophysiological Techniques
lcsh:R
Biology and Life Sciences
Fluid Dynamics
Stroke Volume
medicine.disease
Turbulence
Death
Sudden
Cardiac
ROC Curve
Heart failure
Metabolic Disorders
Chronic Disease
Multivariate Analysis
Cardiovascular Anatomy
Enzymology
lcsh:Q
Cardiac Electrophysiology
Heart-Assist Devices
Therapy
Stratification
business
Biomarkers
Ejection Fraction
Zdroj: PLoS ONE, Vol 12, Iss 10, p e0186152 (2017)
PLoS ONE
R-USJ: Repositorio Institucional de la Universidad San Jorge
Universidad San Jorge (USJ)
Dipòsit Digital de Documents de la UAB
Universitat Autònoma de Barcelona
PLOS ONE
Zaguán. Repositorio Digital de la Universidad de Zaragoza
instname
Popis: Altres ajuts: Gobierno de Aragon BSICoS group (T96) ; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina MULTITOOLS2HEART ; European Social Fund BSICoS group (T96) Sudden cardiac death (SCD) and pump failure death (PFD) are common endpoints in chronic heart failure (CHF) patients, but prevention strategies are different. Currently used tools to specifically predict these endpoints are limited. We developed risk models to specifically assess SCD and PFD risk in CHF by combining ECG markers and clinical variables. The relation of clinical and ECG markers with SCD and PFD risk was assessed in 597 patients enrolled in the MUSIC (MUerte Súbita en Insuficiencia Cardiaca) study. ECG indices included: turbulence slope (TS), reflecting autonomic dysfunction; T-wave alternans (TWA), reflecting ventricular repolarization instability; and T-peak-to-end restitution (Δ α Tpe ) and T-wave morphology restitution (TMR), both reflecting changes in dispersion of repolarization due to heart rate changes. Standard clinical indices were also included. The indices with the greatest SCD prognostic impact were gender, New York Heart Association (NYHA) class, left ventricular ejection fraction, TWA, Δ α Tpe and TMR. For PFD, the indices were diabetes, NYHA class, Δ α Tpe and TS. Using a model with only clinical variables, the hazard ratios (HRs) for SCD and PFD for patients in the high-risk group (fifth quintile of risk score) with respect to patients in the low-risk group (first and second quintiles of risk score) were both greater than 4. HRs for SCD and PFD increased to 9 and 11 when using a model including only ECG markers, and to 14 and 13, when combining clinical and ECG markers. The inclusion of ECG markers capturing complementary pro-arrhythmic and pump failure mechanisms into risk models based only on standard clinical variables substantially improves prediction of SCD and PFD in CHF patients.
Databáze: OpenAIRE
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