Spectral analysis-based risk score enables early prediction of mortality and cerebral performance in patients undergoing therapeutic hypothermia for ventricular fibrillation and comatose status

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:186

Article

Filgueiras-Rama, David^1,3,4  Calvo, Conrado J.^2,5  Salvador-Montanes, Oscar⁴  Cadenas, Rosalia⁴  Ruiz-Cantador, Jose⁴  Armada, Eduardo⁴  Ramon Rey, Juan⁴  Merino, J. L.⁴  Peinado, Rafael⁴  Perez-Castellano, Nicasio³  Perez-Villacastin, Julian³  Quintanilla, Jorge G.¹  Jimenez, Santiago²  Castells, Francisco^2,5  Chorro, Francisco J.⁵  Lopez-Sendon, J. L.⁴  Berenfeld, Omer⁶  Jalife, Jose^1,6  Lopez de Sa, Esteban⁴  Millet, Jose^2,5 

[1] Fdn Ctr Nacl Invest Cardiovasc CNIC, Atherothrombosis Imaging & Epidemiol Dept, Madrid, Spain

[2] Univ Politecn Valencia, Dpto Ingn Elect, Inst Aplicac Avanzadas, BioITACA Grp Bioingn, E-46022 Valencia, Spain

[3] Hosp Clin San Carlos, Madrid, Spain

[4] Hosp Univ La Paz, IdiPaz, Madrid, Spain

[5] Fdn INCLIVA Hosp Clin, Dept Med, Grp Electrofisiol & Bioingn, Microcluster Protecc Cardiovasc, Valencia, Spain

[6] Univ MI, Dept Internal Med, Cardiovasc Res Ctr, Ctr Arrhythmia Res, Ann Arbor, MI USA

关键词: Cardiac arrest;    Cerebral injury;    Early prognosis;    Ventricular fibrillation;    Dominant frequency;   

DOI  :  10.1016/j.ijcard.2015.03.074

来源: Elsevier

【 摘 要 】

Background: Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival. Methods: Sixty-one out of 239 consecutive patients undergoingmild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclusion criteria. Background clinical variables, VF time and frequency domain fundamental variables were considered. The primary and secondary outcomes were a favorable neurological performance (FNP) during hospitalization and survival to hospital discharge, respectively. The predictive modelwas developed in a retrospective cohort (n = 32; September 2006-September 2011, 48.5 +/- 10.5 months of follow-up) and further validated in a prospective cohort (n = 29; October 2011-July 2013, 5 +/- 1.8 months of follow-up). Results: FNPwas present in 16 (50.0%) and 21 patients (72.4%) in the retrospective and prospective cohorts, respectively. Seventeen (53.1%) and 21 patients (72.4%), respectively, survived to hospital discharge. Both outcomes were significantly associated (p < 0.001). Retrospective multivariate analysis provided a prediction model (sensitivity = 0.94, specificity = 1) that included spectral dominant frequency, derived power density and peak ratios between high and low frequency bands, and the number of shocks delivered before ROSC. Validation on the prospective cohort showed sensitivity = 0.88 and specificity = 0.91. A model-derived risk-score properly predicted 93% of FNP. Testing the model on follow-up showed a c-statistic = 0.89. Conclusions: A spectral analysis-basedmodel reliably correlates time-dependent VF spectral changes with acute cerebral injury in comatose survivors undergoing mild hypothermia after cardiac arrest. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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