Differential multivariable risk prediction of appropriate shock versus competing mortality - A prospective cohort study to estimate benefits from ICD therapy

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:272

Article

Bergau, Leonard¹  Willems, Rik²  Sprenkeler, David J.³  Fischer, Thomas H.¹  Flevari, Panayota⁵  Hasenfuss, Gerd^1,6  Katsaras, Dimitrios⁵  Kirova, Aleksandra¹  Lehnart, Stephan E.^1,6  Luethje, Lars¹  Roever, Christian⁷  Seegers, Joachim^1,8  Sossalla, Samuel^1,8  Dunnink, Albert³  Sritharan, Rajevaa¹  Tuinenburg, Anton E.⁴  Vandenberk, Bert²  Vos, Marc A.³  Wijers, Sofieke C.^3,4  Friede, Tim^6,7  Zabel, Markus^1,6 

[1] Univ Med Ctr Gottingen, Dept Cardiol & Pneumol, Gottingen, Germany

[2] Univ Hosp Leuven, Leuven, Belgium

[3] Univ Med Ctr Utrecht, Dept Med Physiol, Utrecht, Netherlands

[4] Univ Med Ctr Utrecht, Dept Cardiol, Utrecht, Netherlands

[5] Attikon Univ Hosp, Dept Cardiol, Athens, Greece

[6] DZHF German Ctr Cardiovasc Res, partner Site Gottingen, Gottingen, Germany

[7] Univ Med Ctr Gottingen, Dept Med Stat, Gottingen, Germany

[8] Univ Hosp Regensburg, Dept Internal Med 2, Div Cardiol, Regensburg, Germany

关键词: Implantable cardioverter defibrillator;    Risk factors;    Mortality;    Sudden cardiac death;   

DOI  :  10.1016/j.ijcard.2018.06.103

来源: Elsevier

【 摘 要 】

Background and objective: We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics in a cohort study of ICD patients. Methods: For 672 enrolled patients, we collected history, LVEF, EP study and T-wave altemans testing, 24-h Hotter, IsiT-proBNP, and the eGFR All-cause mortality and first appropriate ICD shock were predefined endpoints. Results: The 635 patients included in the final analyses were 63 +/- 13 years old, 81% were male, LVEF averaged 40 +/- 14%. 20% were inducible at EP study, 63% had a primary prophylactic ICD. During follow-up over 4.3 +/- 15 years, 108 patients died (4.0% per year), and appropriate shock therapy occurred inn - 96 (3.9% per year). In multivariate regression, age (p < 0.001), LVEF (p < 0.001), NYHA functional class (p = 0.007), eGFR (p = 0.024), a history of atrial fibrillation (p = 0.011). and NT-pro-BNP (p = 0.002) were predictors of mortality. LVEF (p = 0.002), inducibility at EP study (p = 0.007). and secondary prophylaxis (p = 0.002) were identified as independent predictors of appropriate shocks. A high annualized risk of shocks of about 10% per year was prevalent in the upper quintile of the shock score. In contrast, a low annual risk of shocks (1.8% per year) was found in the lower two quintiles of the shock score. The lower two quintiles of the mortality score featured an annual mortality <0.6%. Conclusions: In a prospective ICD patient cohort, a very good approximation of mortality versus arrhythmic risk was possible using a multivariable diagnostic strategy. EP stimulation is the best test to assess risk of arrhythmias resulting in ICD shocks. (C) 2018 The Authors. Published by Elsevier B.V.

【 授权许可】

Free