Authors: Mauricio Pimentel André Zimerman Diego Chemello Vanessa Giaretta Michael Andrades Daiane Silvello Leandro Zimerman Luis E Rohde
Publish Date: 2016/12/10
Volume: 48, Issue: 2, Pages: 131-139
Abstract
Risk stratification of serious arrhythmic events in patients with nonischemic heart failure HF beyond estimates of left ventricular ejection fraction LVEF remains an important clinical challenge This study aims to determine the clinical value of different noninvasive and invasive tests as predictors of serious arrhythmic events in patients with nonischemic HFA prospective observational study was conducted including 106 nonischemic HF patients who underwent a comprehensive clinical and laboratory evaluation including twodimensional echocardiography 24h Holter monitoring cardiopulmonary exercise testing CPX and an invasive electrophysiological study The study’s primary endpoint was either syncope appropriate therapy by implantable cardioverterdefibrillators or sudden cardiac deathDuring a mean followup of 704 ± 320 days the primary endpoint occurred in 15 patients 142 In multivariable analysis LV enddiastolic diameter 73 mm hazard ratio HR 37 p = 0016 exercise periodic breathing EPB on CPX HR 288 p = 0045 and nonsustained ventricular tachycardia NSVT ≥10 beats HR 82 p 001 remained independently associated with serious arrhythmic events The positive predictive value of the presence of two of these predictors ranged from 44 to 100 The absence of all three factors n = 65 61 of the sample identified a subset of patients with low risk of future arrhythmic events with a negative predictive value of 969In this cohort study of nonischemic HF patients LV dimension EPB and NSVT ≥10 beats were independent predictors of serious arrhythmic events The presence or absence of these characteristics identified subgroups of high and low risk of serious arrhythmic events respectively
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