Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post-myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRESERVE-EF study

Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc

article

Konstantinos Trachanas¹  Skevos Sideris¹  Petros Arsenos²  Dimitrios Tsiachris²  Christos-Konstantinos Antoniou²  Polychronis Dilaveris²  Konstantinos Triantafyllou³  Iosif Xenogiannis⁴  Konstantinos Tsimos MD, MSc, PhD⁵  Michalis Efremidis⁶  Emmanuel Kanoupakis⁷  Panagiota Flevari⁴  Vassilios Vassilikos³  Antonios Sideris⁶  Panagiotis Korantzopoulos⁵  Dimitrios Tousoulis²  Konstantinos Tsioufis²  Konstantinos Gatzoulis² 

[1] State Department of Cardiology, Hippokrateion General Hospital;First Department of Cardiology, Hippokrateion General Hospital, National and Kapodistrian University of Athens School of Medicine;Third Department of Cardiology, Aristotle University of Thessaloniki;Second Department of Cardiology, Attikon General Hospital, National and Kapodistrian University of Athens School of Medicine;Department of Cardiology, Faculty of Medicine, University of Ioannina;Second State Department of Cardiology, Evangelismos Athens General Hospital;Department of Cardiology, Heraklion University Hospital, University of Crete, School of Medicine

关键词: cardiac arrest/sudden cardiac death;    Holter/event recorders;    signal-averaged ECG;    ventricular tachycardia/fibrillation;   

DOI  :  10.1111/anec.12908

来源: Wiley

【 摘 要 】

Background In the PRESERVE-EF study, a two-step sudden cardiac death (SCD) risk stratification approach to detect post-myocardial infarction (MI) patients with left ventricle ejection fraction (LVEF) ≥40% at risk for major arrhythmic events (MAEs) was used. Seven noninvasive risk factors (NIRFs) were extracted from a 24-h ambulatory electrocardiography (AECG) and a 45-min resting recording. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS) and inducible patients received an Implantable Cardioverter - Defibrillator (ICD). Methods In the present study, we evaluated the performance of the NIRFs, as they were described in the PRESERVE-EF study protocol, in predicting a positive PVS. In the PRESERVE-EF study, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analyzed. Results Among the NIRFs examined, the presence of signal averaged ECG-late potentials (SAECG-LPs) ≥ 2/3 and non-sustained ventricular tachycardia (NSVT) ≥1 eposode/24 h cutoff points were important predictors of a positive PVS study, demonstrating in the logistic regression analysis odds ratios 2.285 ( p  = .027) and 2.867 ( p  = .006), respectively. A simple risk score based on the above cutoff points in combination with LVEF < 50% presented high sensitivity but low specificity for a positive PVS. Conclusion Cutoff points of NSVT ≥ 1 episode/24 h and SAECG-LPs ≥ 2/3 in combination with a LVEF < 50% were important predictors of inducibility. However, the final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.

【 授权许可】

Unknown