Electrocardiographic predictors of sudden and non-sudden cardiac death in patients with ischemic cardiomyopathy
Abstract Objective This study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among ischemic cardiomyopathy patients with depressed left ventricular ejection fraction (LVEF ≤35%). Background The prediction of cause-s...
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Published in | Heart & lung Vol. 43; no. 6; pp. 527 - 533 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.11.2014
Elsevier Science Ltd |
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Abstract | Abstract Objective This study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among ischemic cardiomyopathy patients with depressed left ventricular ejection fraction (LVEF ≤35%). Background The prediction of cause-specific mortality in high-risk patients offers the potential for targeting specific therapies (i.e., implantable cardioverter-defibrillator [ICD]). Methods Subjects were recruited from the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) study. Continuous Holter 12-lead ECG recordings were obtained at the start of study and used to compute 15 clinically-important ECG abnormalities (e.g., atrial fibrillation). Results Among 197 patients (age 67 ± 11 years, 93% male, mean follow-up 4.1 years) enrolled, 30 (15%) were SCA cases and 35 (18%) cardiac non-sudden deaths (C/NS). In multivariate analysis, only heart-rate-corrected QT interval (QTc) predicted SCA (hazard ratio 2.9 [1.2–7.3]) and only depressed heart rate variability (HRV) predicted C/NS (hazard ratio 5.0 [1.5–17.1]) independent of demographic and clinical parameters. Conclusions Among patients with depressed LVEF, prolonged QTc suggests greater potential benefit from ICD therapy to prevent SCA; depressed HRV suggests potential benefit from bi-ventricular pacing to prevent C/NS. |
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AbstractList | This study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among ischemic cardiomyopathy patients with depressed left ventricular ejection fraction (LVEF ≤35%).
The prediction of cause-specific mortality in high-risk patients offers the potential for targeting specific therapies (i.e., implantable cardioverter-defibrillator [ICD]).
Subjects were recruited from the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) study. Continuous Holter 12-lead ECG recordings were obtained at the start of study and used to compute 15 clinically-important ECG abnormalities (e.g., atrial fibrillation).
Among 197 patients (age 67 ± 11 years, 93% male, mean follow-up 4.1 years) enrolled, 30 (15%) were SCA cases and 35 (18%) cardiac non-sudden deaths (C/NS). In multivariate analysis, only heart-rate-corrected QT interval (QTc) predicted SCA (hazard ratio 2.9 [1.2-7.3]) and only depressed heart rate variability (HRV) predicted C/NS (hazard ratio 5.0 [1.5-17.1]) independent of demographic and clinical parameters.
Among patients with depressed LVEF, prolonged QTc suggests greater potential benefit from ICD therapy to prevent SCA; depressed HRV suggests potential benefit from bi-ventricular pacing to prevent C/NS. This study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among ischemic cardiomyopathy patients with depressed left ventricular ejection fraction (LVEF ≤35%). The prediction of cause-specific mortality in high-risk patients offers the potential for targeting specific therapies (i.e., implantable cardioverter-defibrillator [ICD]). Subjects were recruited from the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) study. Continuous Holter 12-lead ECG recordings were obtained at the start of study and used to compute 15 clinically-important ECG abnormalities (e.g., atrial fibrillation). Among 197 patients (age 67 ± 11 years, 93% male, mean follow-up 4.1 years) enrolled, 30 (15%) were SCA cases and 35 (18%) cardiac non-sudden deaths (C/NS). In multivariate analysis, only heart-rate-corrected QT interval (QTc) predicted SCA (hazard ratio 2.9 [1.2–7.3]) and only depressed heart rate variability (HRV) predicted C/NS (hazard ratio 5.0 [1.5–17.1]) independent of demographic and clinical parameters. Among patients with depressed LVEF, prolonged QTc suggests greater potential benefit from ICD therapy to prevent SCA; depressed HRV suggests potential benefit from bi-ventricular pacing to prevent C/NS. -The ECG is a simple and valuable tool to identify patients at greater risk for adverse cardiac events-Novel approaches to analyze the ECG in the presence of interpretation confounders are needed This study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among ischemic cardiomyopathy patients with depressed left ventricular ejection fraction (LVEF ≤35%). The prediction of cause-specific mortality in high-risk patients offers the potential for targeting specific therapies (i.e., implantable cardioverter-defibrillator [ICD]). Subjects were recruited from the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) study. Continuous Holter 12-lead ECG recordings were obtained at the start of study and used to compute 15 clinically-important ECG abnormalities (e.g., atrial fibrillation). Among 197 patients (age 67 ± 11 years, 93% male, mean follow-up 4.1 years) enrolled, 30 (15%) were SCA cases and 35 (18%) cardiac non-sudden deaths (C/NS). In multivariate analysis, only heart-rate-corrected QT interval (QTc) predicted SCA (hazard ratio 2.9 [1.2-7.3]) and only depressed heart rate variability (HRV) predicted C/NS (hazard ratio 5.0 [1.5-17.1]) independent of demographic and clinical parameters. Among patients with depressed LVEF, prolonged QTc suggests greater potential benefit from ICD therapy to prevent SCA; depressed HRV suggests potential benefit from bi-ventricular pacing to prevent C/NS. OBJECTIVEThis study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among ischemic cardiomyopathy patients with depressed left ventricular ejection fraction (LVEF ≤35%). BACKGROUNDThe prediction of cause-specific mortality in high-risk patients offers the potential for targeting specific therapies (i.e., implantable cardioverter-defibrillator [ICD]). METHODSSubjects were recruited from the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) study. Continuous Holter 12-lead ECG recordings were obtained at the start of study and used to compute 15 clinically-important ECG abnormalities (e.g., atrial fibrillation). RESULTSAmong 197 patients (age 67 ± 11 years, 93% male, mean follow-up 4.1 years) enrolled, 30 (15%) were SCA cases and 35 (18%) cardiac non-sudden deaths (C/NS). In multivariate analysis, only heart-rate-corrected QT interval (QTc) predicted SCA (hazard ratio 2.9 [1.2-7.3]) and only depressed heart rate variability (HRV) predicted C/NS (hazard ratio 5.0 [1.5-17.1]) independent of demographic and clinical parameters. CONCLUSIONSAmong patients with depressed LVEF, prolonged QTc suggests greater potential benefit from ICD therapy to prevent SCA; depressed HRV suggests potential benefit from bi-ventricular pacing to prevent C/NS. Abstract Objective This study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among ischemic cardiomyopathy patients with depressed left ventricular ejection fraction (LVEF ≤35%). Background The prediction of cause-specific mortality in high-risk patients offers the potential for targeting specific therapies (i.e., implantable cardioverter-defibrillator [ICD]). Methods Subjects were recruited from the Prediction of Arrhythmic Events with Positron Emission Tomography (PAREPET) study. Continuous Holter 12-lead ECG recordings were obtained at the start of study and used to compute 15 clinically-important ECG abnormalities (e.g., atrial fibrillation). Results Among 197 patients (age 67 ± 11 years, 93% male, mean follow-up 4.1 years) enrolled, 30 (15%) were SCA cases and 35 (18%) cardiac non-sudden deaths (C/NS). In multivariate analysis, only heart-rate-corrected QT interval (QTc) predicted SCA (hazard ratio 2.9 [1.2–7.3]) and only depressed heart rate variability (HRV) predicted C/NS (hazard ratio 5.0 [1.5–17.1]) independent of demographic and clinical parameters. Conclusions Among patients with depressed LVEF, prolonged QTc suggests greater potential benefit from ICD therapy to prevent SCA; depressed HRV suggests potential benefit from bi-ventricular pacing to prevent C/NS. |
Author | Al-Zaiti, Salah S., PhD Carey, Mary G., PhD Canty, John M., MD Fallavollita, James A., MD |
AuthorAffiliation | 7 Strong Memorial Hospital at University of Rochester Medical Center, Rochester NY 2 VA WNY Health Care System at Buffalo, University at Buffalo, NY 1 Acute and Tertiary Care Department at University of Pittsburgh PA 6 Center for Research in Cardiovascular Medicine, University at Buffalo, NY 3 Department of Medicine, University at Buffalo, NY 5 Department of Biomedical Engineering, University at Buffalo, NY 4 Department of Physiology & Biophysics, University at Buffalo, NY |
AuthorAffiliation_xml | – name: 3 Department of Medicine, University at Buffalo, NY – name: 6 Center for Research in Cardiovascular Medicine, University at Buffalo, NY – name: 7 Strong Memorial Hospital at University of Rochester Medical Center, Rochester NY – name: 1 Acute and Tertiary Care Department at University of Pittsburgh PA – name: 2 VA WNY Health Care System at Buffalo, University at Buffalo, NY – name: 4 Department of Physiology & Biophysics, University at Buffalo, NY – name: 5 Department of Biomedical Engineering, University at Buffalo, NY |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/24996250$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1016_j_jelectrocard_2015_06_013 crossref_primary_10_1371_journal_pone_0164526 crossref_primary_10_1007_s10840_017_0308_9 crossref_primary_10_2174_0118750362295563240620111209 crossref_primary_10_1016_j_bpj_2019_08_020 crossref_primary_10_1111_pace_13180 crossref_primary_10_1155_2015_727401 crossref_primary_10_1016_j_jelectrocard_2018_11_006 crossref_primary_10_1016_j_ijcard_2022_03_009 crossref_primary_10_1177_1099800419877442 crossref_primary_10_1080_14017431_2016_1215520 |
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Keywords | Sudden cardiac arrest Electrocardiogram Implantable cardioverter defibrillator Ischemic cardiomyopathy |
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Snippet | Abstract Objective This study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest... This study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among ischemic... OBJECTIVEThis study evaluated the prognostic value of electrocardiogram (ECG)-based predictors in the primary prevention of sudden cardiac arrest (SCA) among... |
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SubjectTerms | Aged Cardiovascular Critical Care Death, Sudden, Cardiac - etiology Death, Sudden, Cardiac - prevention & control Defibrillators, Implantable Electrocardiogram Electrocardiography Female Follow-Up Studies Heart Heart attacks Heart Rate - physiology Humans Implantable cardioverter defibrillator Ischemic cardiomyopathy Male Middle Aged Mortality Myocardial Ischemia - complications Patients Prospective Studies Pulmonary/Respiratory Sudden cardiac arrest Ventricular Function, Left - physiology |
Title | Electrocardiographic predictors of sudden and non-sudden cardiac death in patients with ischemic cardiomyopathy |
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