Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: the PRESERVE EF study
| Autor: | Konstantinos Gatzoulis, Vassilios Vassilikos, Skevos Sideris, Konstantinos Trachanas, Petros Arsenos, Dimitrios Tsiachris, Emmanouil Simantirakis, Christos-Konstantinos Antoniou, Ioannis Kallikazaros, Iosif Xenogiannis, Michail Vernardos, Ioannis Konstantinou, Konstantinos Triantafyllou, Konstantinos Vlachos, Emmanuel M. Kanoupakis, Panagiotis Korantzopoulos, Athanasios Saplaouras, Nikolaos Fragakis, Antonios Sideris, Ioannis Goudevenos, Efstathios K. Iliodromitis, Panagiota Flevari, Polychronis Dilaveris, Konstantinos Tsimos, Dimitrios Tousoulis |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Myocardial Infarction Infarction 030204 cardiovascular system & hematology Ventricular tachycardia Sudden cardiac death Cohort Studies Electrocardiography 0302 clinical medicine 030212 general & internal medicine Myocardial infarction Prospective Studies Coronary Artery Bypass education.field_of_study Ejection fraction Arrhythmia/Electrophysiology Cardiac Pacing Artificial T wave alternans Middle Aged Defibrillators Implantable Ventricular Fibrillation cardiovascular system Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine Adult medicine.medical_specialty Arrhythmic risk stratification Population Monitoring Ambulatory Risk Assessment 03 medical and health sciences Clinical Research Internal medicine medicine Humans Programmed ventricular stimulation cardiovascular diseases education Aged Fibrillation business.industry Arrhythmias Cardiac Stroke Volume Preserved ejection fraction medicine.disease Editor's Choice Two-step approach Death Sudden Cardiac Tachycardia Ventricular business Follow-Up Studies |
| Zdroj: | European Heart Journal |
| ISSN: | 1522-9645 |
| Popis: | 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 |
| Databáze: | OpenAIRE |
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