Repeating noninvasive risk stratification improves prediction of outcome in ICD patients

Background Noninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter‐defibrillator (ICD). Methods The EUTrigTreat...

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Published in:Annals of noninvasive electrocardiology 2020-11, Vol.25 (6), p.e12794-n/a
Main Authors: Vandenberk, Bert, Floré, Vincent, Röver, Christian, Vos, Mark A., Dunnink, Albert, Leftheriotis, Dionyssios, Friede, Tim, Flevari, Panagiota, Zabel, Markus, Willems, Rik
Format: Article
Language:English
Subjects:
Abnormalities
autonomic function
Cardiac arrhythmia
Cardiovascular diseases
Coronary artery disease
EKG
Heart diseases
Heart rate
Heart rate turbulence
Ischemia
left ventricular ejection fraction
microvolt T‐wave alternans
Mortality
noninvasive risk stratification
Original
Regression analysis
Risk
sudden cardiac death
Ventricle
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Summary:Background Noninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter‐defibrillator (ICD). Methods The EUTrigTreat clinical study was a prospective multicenter trial including ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease. Left ventricular ejection fraction ≤40% (LVEF), premature ventricular complexes >400/24 hr (PVC), non‐negative microvolt T‐wave alternans (MTWA), and abnormal heart rate turbulence (HRT) were considered high risk. Tests were repeated within 12 months after inclusion. Adjusted Cox regression analysis was performed for mortality and appropriate ICD shocks. Results In total, 635 patients had analyzable baseline data with a median follow‐up of 4.4 years. Worsening of LVEF was associated with increased mortality (HR 3.59, 95% CI 1.17–11.04), as was consistent abnormal HRT (HR 8.34, 95%CI 1.06–65.54). HRT improvement was associated with improved survival when compared to consistent abnormal HRT (HR 0.10, 95%CI 0.01–0.82). For appropriate ICD shocks, a non‐negative MTWA test or high PVC count at any moment was associated with increased arrhythmic risk independent of the evolution of test results (worsening: HR 3.76 (95%CI 1.43–9.88) and HR 2.50 (95%CI 1.15–5.46); improvement: HR 2.80 (95%CI 1.03–7.61) and HR 2.45 (95%CI 1.07–5.62); consistent: HR 2.47 (95%CI 0.95–6.45) and HR 2.40 (95%CI 1.33–4.33), respectively). LVEF improvement was associated with a lower arrhythmic risk (HR 0.34, 95%CI 0.12–0.94). Conclusions Repeating LVEF and HRT improved the prediction of mortality, whereas stratification of ventricular arrhythmias may be improved by repeating LVEF measurements, MTWA and ECG Holter monitoring.
ISSN:1082-720X
1542-474X
DOI:10.1111/anec.12794