Predictors of Subcutaneous Implantable Cardioverter-Defibrillator Shocks and Prognostic Impact in Patients With Structural Heart Disease
| Autor: | Hugues Blangy, Sandro Ninni, Jean-Baptiste Gouraud, Vincent Probst, Didier Klug, Julien Labreuche, Marine Arnaud, Antoine Andorin, Staniel Ortmans, Christelle Marquié, Elodie Drumez, Nicolas Sadoul, Charlotte Potelle, Antoine Cuvillier, Matthieu Echivard, Juliette Lemaire |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Heart disease medicine.medical_treatment Cardiomyopathy Electric Countershock 030204 cardiovascular system & hematology Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans 030212 general & internal medicine Registries Treatment Failure Retrospective Studies Heart Failure Ejection fraction Proportional hazards model business.industry Hazard ratio Implantable cardioverter-defibrillator medicine.disease Prognosis Defibrillators Implantable Hospitalization Death Sudden Cardiac Shock (circulatory) Heart failure Cardiology Female France medicine.symptom Cardiology and Cardiovascular Medicine business Cardiomyopathies |
| Zdroj: | The Canadian journal of cardiology. 37(3) |
| ISSN: | 1916-7075 |
| Popis: | Background In this study we aimed to assess long-term outcomes in subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with structural heart disease by focussing especially on shock incidence, predictors, and associated prognoses. Methods In this multicenter registry‒based study, we retrospectively included all patients who underwent S-ICD implantation at 3 tertiary centers. The prognostic impact of S-ICD shock was assessed with a composite outcome that included all-cause death and hospitalisation for heart failure. Results A total of 351 patients with underlying cardiomyopathy were included in the investigation. Using multivariable Fine and Gray regression models, secondary prevention, left ventricular ejection fraction (LVEF), conditional shock threshold, and QRS duration appeared to be independent predictors of appropriate S-ICD shock occurrence. In the multivariate Cox regression model adjusted for age, baseline LVEF, underlying cardiomyopathy subtype, New York Heart Association class, and appropriate shocks were significantly associated with increased composite prognostic outcome risk (hazard ratio [HR], 2.61; 95% confidence interval [CI], 1.21-5.65; P = 0.014), whereas inappropriate shocks were not (HR, 1.35; 95% CI, 0.75-4.48; P = 0.18). The analysis of each component of the composite prognostic outcome highlighted that the occurrence of appropriate shocks was associated with an increased risk of hospitalisation for heart failure (HR, 3.10; 95% CI, 1.26-7.58; P = 0.013) and a trend for mortality (HR, 2.19; 95% CI, 0.78-6.16; P = 0.14). Conclusions Appropriate S-ICD shocks were associated with a 3-fold increase in acute heart failure admission, whereas inappropriate shocks were not. Conditional shock threshold programming is an independent predictor of S-ICD shock, and its prognostic impact should be investigated further in patients with structural heart disease. |
| Databáze: | OpenAIRE |
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