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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 |
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| creator | Vandenberk, Bert Floré, Vincent Röver, Christian Vos, Mark A. Dunnink, Albert Leftheriotis, Dionyssios Friede, Tim Flevari, Panagiota Zabel, Markus Willems, Rik |
| description | 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. |
| doi_str_mv | 10.1111/anec.12794 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7679829</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2462594219</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4484-a093f9742a8b70e1ca2664c381466f626fd6620604fc6b239b15c7cd47388c63</originalsourceid><addsrcrecordid>eNp9kUFPHCEUx0lTU63txQ9gSHoxTUbhzRuYuTQxW2tNjCbGw94IyzKKzsAIM9v47cu6aqqHcgDC--XHgz8he5wd8jyOtLfmkINs8APZ4RVCgRLnH_Oe1VBIYPNt8jmlO8YAEOQnsl1CzRB5tUPmV3awenT-hvrgnV_p5FaWRpfuaRpjrrTO5Dl46vohhpVNdIh26czTWWhpmEYTekudp2ezn3TIsPVj-kK2Wt0l-_V53SXXv06uZ7-L88vTs9nxeWEQayw0a8q2kQi6XkhmudEgBJqy5ihEK0C0SyGACYatEQsomwWvjDRLlGVdG1Hukh8b7TAters0-eqoOzVE1-v4qIJ26m3Fu1t1E1ZKCtnU0GTBwbMghofJplH1LhnbdflXw5QUYImyEsB5Rr-9Q-_CFH1-XaYEVA0CXwu_bygTQ0rRtq_NcKbWeal1Xuoprwzv_9v-K_oSUAb4BvjjOvv4H5U6vjiZbaR_AedQoRg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2462594219</pqid></control><display><type>article</type><title>Repeating noninvasive risk stratification improves prediction of outcome in ICD patients</title><source>Wiley</source><source>PubMed Central（OA）</source><source>ProQuest - Publicly Available Content Database</source><creator>Vandenberk, Bert ; Floré, Vincent ; Röver, Christian ; Vos, Mark A. ; Dunnink, Albert ; Leftheriotis, Dionyssios ; Friede, Tim ; Flevari, Panagiota ; Zabel, Markus ; Willems, Rik</creator><creatorcontrib>Vandenberk, Bert ; Floré, Vincent ; Röver, Christian ; Vos, Mark A. ; Dunnink, Albert ; Leftheriotis, Dionyssios ; Friede, Tim ; Flevari, Panagiota ; Zabel, Markus ; Willems, Rik</creatorcontrib><description>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.</description><identifier>ISSN: 1082-720X</identifier><identifier>EISSN: 1542-474X</identifier><identifier>DOI: 10.1111/anec.12794</identifier><identifier>PMID: 32804415</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>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</subject><ispartof>Annals of noninvasive electrocardiology, 2020-11, Vol.25 (6), p.e12794-n/a</ispartof><rights>2020 The Authors. published by Wiley Periodicals LLC</rights><rights>2020 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.</rights><rights>Copyright Wiley Subscription Services, Inc. Nov 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4484-a093f9742a8b70e1ca2664c381466f626fd6620604fc6b239b15c7cd47388c63</citedby><cites>FETCH-LOGICAL-c4484-a093f9742a8b70e1ca2664c381466f626fd6620604fc6b239b15c7cd47388c63</cites><orcidid>0000-0001-5347-7441 ; 0000-0001-8296-920X ; 0000-0002-5469-9609 ; 0000-0002-6911-698X ; 0000-0003-1245-8919 ; 0000-0003-0895-4602 ; 0000-0002-3970-7842</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanec.12794$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fanec.12794$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,315,733,786,790,891,27957,27958,37047,37048,50923,51032,53827,53829</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32804415$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vandenberk, Bert</creatorcontrib><creatorcontrib>Floré, Vincent</creatorcontrib><creatorcontrib>Röver, Christian</creatorcontrib><creatorcontrib>Vos, Mark A.</creatorcontrib><creatorcontrib>Dunnink, Albert</creatorcontrib><creatorcontrib>Leftheriotis, Dionyssios</creatorcontrib><creatorcontrib>Friede, Tim</creatorcontrib><creatorcontrib>Flevari, Panagiota</creatorcontrib><creatorcontrib>Zabel, Markus</creatorcontrib><creatorcontrib>Willems, Rik</creatorcontrib><title>Repeating noninvasive risk stratification improves prediction of outcome in ICD patients</title><title>Annals of noninvasive electrocardiology</title><addtitle>Ann Noninvasive Electrocardiol</addtitle><description>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.</description><subject>Abnormalities</subject><subject>autonomic function</subject><subject>Cardiac arrhythmia</subject><subject>Cardiovascular diseases</subject><subject>Coronary artery disease</subject><subject>EKG</subject><subject>Heart diseases</subject><subject>Heart rate</subject><subject>Heart rate turbulence</subject><subject>Ischemia</subject><subject>left ventricular ejection fraction</subject><subject>microvolt T‐wave alternans</subject><subject>Mortality</subject><subject>noninvasive risk stratification</subject><subject>Original</subject><subject>Regression analysis</subject><subject>Risk</subject><subject>sudden cardiac death</subject><subject>Ventricle</subject><issn>1082-720X</issn><issn>1542-474X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNp9kUFPHCEUx0lTU63txQ9gSHoxTUbhzRuYuTQxW2tNjCbGw94IyzKKzsAIM9v47cu6aqqHcgDC--XHgz8he5wd8jyOtLfmkINs8APZ4RVCgRLnH_Oe1VBIYPNt8jmlO8YAEOQnsl1CzRB5tUPmV3awenT-hvrgnV_p5FaWRpfuaRpjrrTO5Dl46vohhpVNdIh26czTWWhpmEYTekudp2ezn3TIsPVj-kK2Wt0l-_V53SXXv06uZ7-L88vTs9nxeWEQayw0a8q2kQi6XkhmudEgBJqy5ihEK0C0SyGACYatEQsomwWvjDRLlGVdG1Hukh8b7TAters0-eqoOzVE1-v4qIJ26m3Fu1t1E1ZKCtnU0GTBwbMghofJplH1LhnbdflXw5QUYImyEsB5Rr-9Q-_CFH1-XaYEVA0CXwu_bygTQ0rRtq_NcKbWeal1Xuoprwzv_9v-K_oSUAb4BvjjOvv4H5U6vjiZbaR_AedQoRg</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Vandenberk, Bert</creator><creator>Floré, Vincent</creator><creator>Röver, Christian</creator><creator>Vos, Mark A.</creator><creator>Dunnink, Albert</creator><creator>Leftheriotis, Dionyssios</creator><creator>Friede, Tim</creator><creator>Flevari, Panagiota</creator><creator>Zabel, Markus</creator><creator>Willems, Rik</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5347-7441</orcidid><orcidid>https://orcid.org/0000-0001-8296-920X</orcidid><orcidid>https://orcid.org/0000-0002-5469-9609</orcidid><orcidid>https://orcid.org/0000-0002-6911-698X</orcidid><orcidid>https://orcid.org/0000-0003-1245-8919</orcidid><orcidid>https://orcid.org/0000-0003-0895-4602</orcidid><orcidid>https://orcid.org/0000-0002-3970-7842</orcidid></search><sort><creationdate>202011</creationdate><title>Repeating noninvasive risk stratification improves prediction of outcome in ICD patients</title><author>Vandenberk, Bert ; Floré, Vincent ; Röver, Christian ; Vos, Mark A. ; Dunnink, Albert ; Leftheriotis, Dionyssios ; Friede, Tim ; Flevari, Panagiota ; Zabel, Markus ; Willems, Rik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4484-a093f9742a8b70e1ca2664c381466f626fd6620604fc6b239b15c7cd47388c63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abnormalities</topic><topic>autonomic function</topic><topic>Cardiac arrhythmia</topic><topic>Cardiovascular diseases</topic><topic>Coronary artery disease</topic><topic>EKG</topic><topic>Heart diseases</topic><topic>Heart rate</topic><topic>Heart rate turbulence</topic><topic>Ischemia</topic><topic>left ventricular ejection fraction</topic><topic>microvolt T‐wave alternans</topic><topic>Mortality</topic><topic>noninvasive risk stratification</topic><topic>Original</topic><topic>Regression analysis</topic><topic>Risk</topic><topic>sudden cardiac death</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vandenberk, Bert</creatorcontrib><creatorcontrib>Floré, Vincent</creatorcontrib><creatorcontrib>Röver, Christian</creatorcontrib><creatorcontrib>Vos, Mark A.</creatorcontrib><creatorcontrib>Dunnink, Albert</creatorcontrib><creatorcontrib>Leftheriotis, Dionyssios</creatorcontrib><creatorcontrib>Friede, Tim</creatorcontrib><creatorcontrib>Flevari, Panagiota</creatorcontrib><creatorcontrib>Zabel, Markus</creatorcontrib><creatorcontrib>Willems, Rik</creatorcontrib><collection>Wiley_OA刊</collection><collection>Wiley Free Archive</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of noninvasive electrocardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vandenberk, Bert</au><au>Floré, Vincent</au><au>Röver, Christian</au><au>Vos, Mark A.</au><au>Dunnink, Albert</au><au>Leftheriotis, Dionyssios</au><au>Friede, Tim</au><au>Flevari, Panagiota</au><au>Zabel, Markus</au><au>Willems, Rik</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Repeating noninvasive risk stratification improves prediction of outcome in ICD patients</atitle><jtitle>Annals of noninvasive electrocardiology</jtitle><addtitle>Ann Noninvasive Electrocardiol</addtitle><date>2020-11</date><risdate>2020</risdate><volume>25</volume><issue>6</issue><spage>e12794</spage><epage>n/a</epage><pages>e12794-n/a</pages><issn>1082-720X</issn><eissn>1542-474X</eissn><notes>Funding information</notes><notes>This research has received funding from European Community's Seventh Framework Program FP7: EUTrigTreat (grant agreement no. HEALTH‐F2‐2009‐241526).</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>United States</cop><pub>John Wiley & Sons, Inc</pub><pmid>32804415</pmid><doi>10.1111/anec.12794</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-5347-7441</orcidid><orcidid>https://orcid.org/0000-0001-8296-920X</orcidid><orcidid>https://orcid.org/0000-0002-5469-9609</orcidid><orcidid>https://orcid.org/0000-0002-6911-698X</orcidid><orcidid>https://orcid.org/0000-0003-1245-8919</orcidid><orcidid>https://orcid.org/0000-0003-0895-4602</orcidid><orcidid>https://orcid.org/0000-0002-3970-7842</orcidid><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Repeating noninvasive risk stratification improves prediction of outcome in ICD patients |
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