GW25-e4318 Left posterior fascicular branch block was not primary endpoint of ablation idiopathic left ventricular tachycardia and long term outcome

Abstract Background Left ventricular (LV) systolic dysfunction and heart failure (HF) in patients with lower extremity artery disease (LEAD) is associated with an increased risk for adverse events. However, relationship between long-term outcome in patient with LEAD and LV diastolic dysfunction remains unclear. Purpose The aim of this study was to assess the impact of LV diastolic dysfunction on long-term outcome in patients with LEAD. Methods Two hundred patients (male 66%, mean age 76±9 years) with preserved LV systolic function assessed by echocardiography (ejection fraction ≥50%) were enrolled from a single-center database between January 2013 to May 2015. Baseline LEAD was identified by ABI <0.9 or history of lower extremity revascularization. Diagnosis of LV diastolic dysfunction was based on the ASE/EACVI guidelines. The 3-year cumulative incidence of primary endpoint compared between LEAD patients with LV diastolic dysfunction than those without. The primary endpoint was a composite of cardiovascular death, myocardial infarction, stroke and hospitalization for HF during 3 years follow-up. Multivariate analysis was performed to determine whether LV diastolic dysfunction was independently associated with the primary endpoint. Results LV diastolic dysfunction was identified in 31%. The mean observation period was 32±21 months. The primary endpoint occurred more frequently in patients with LV diastolic dysfunction than those without at 3 years (30% vs 16%, P=0.02). There were no significant differences between 2 groups in the myocardial infarction (3% vs 3%, P=0.73) and stroke (3% vs 3%, P=0.55). Cardiovascular death (19% vs 7%, P=0.01) and hospitalization for HF (19% vs 7%, P=0.01) were significantly higher in patients with LV diastolic dysfunction. In multivariate analysis, LV diastolic dysfunction was an independent predictor for primary endpoint (HR=2.28, 95% CI 1.10–4.73, P=0.02) (Table) Predictor for primary endpoint Factors Univariate model Multivariate model Hazard ratio [95% CI] P value Hazard ratio [95% CI] P value Age 1.03 [0.98–1.08] 0.24 1.03 [0.98–1.08] 0.22 Chronic kidney disease 1.53 [0.77–3.07] 0.23 1.25 [0.60–2.58] 0.55 Coronary artery disease 1.08 [0.53–2.18] 0.84 1.18 [0.56–2.50] 0.65 Cerebrovascular disease 1.93 [0.74–5.02] 0.17 2.28 [0.86–6.05] 0.10 Critical limb ischemia 3.75 [1.68–8.37] <0.01 3.72 [0.56–2.50] <0.01 LV diastolic dysfunction 2.37 [1.18–4.74] 0.02 2.28 [1.10–4.73] 0.03 Conclusions LV diastolic dysfunction increased the risk for adverse events in patients with LEAD. Acknowledgement/Funding None

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Surgery for ventricular tachycardia of left ventricular origin: risk factors for success and long-term outcome

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(02)00487-6 ◽

2002 ◽

Vol 22 (5) ◽

pp. 762-770 ◽

Cited By ~ 10

Author(s):

U VONOPPELL ◽

D MILNE ◽

A OKREGLICKI ◽

R SCOTTMILLAR

Keyword(s):

Risk Factors ◽

Ventricular Tachycardia ◽

Left Ventricular ◽

Term Outcome ◽

Long Term Outcome

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Long-term outcome of verapamil-sensitive sustained left ventricular tachycardia in patients without structural heart disease

Journal of the American College of Cardiology ◽

10.1016/0735-1097(94)00324-j ◽

1995 ◽

Vol 25 (1) ◽

pp. 54-58 ◽

Cited By ~ 53

Author(s):

Tohru Ohe ◽

Naohiko Aihara ◽

Shiro Kamakura ◽

Takashi Kurita ◽

Wataru Shimizu ◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Left Ventricular ◽

Term Outcome ◽

Long Term Outcome

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Impact of left ventricular diastolic dysfunction on long-term outcome in patients with lower extremity artery disease

Journal of Cardiology ◽

10.1016/j.jjcc.2019.12.011 ◽

2020 ◽

Vol 75 (6) ◽

pp. 659-664

Author(s):

Koji Yanaka ◽

Hirokuni Akahori ◽

Takahiro Imanaka ◽

Kojiro Miki ◽

Nagataka Yoshihara ◽

...

Keyword(s):

Lower Extremity ◽

Diastolic Dysfunction ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Term Outcome ◽

Long Term Outcome ◽

Ventricular Diastolic Dysfunction ◽

Artery Disease ◽

Lower Extremity Artery Disease

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Systolic blood pressure and outcome in patients admitted with acute heart failure: a pooled analysis from 4 randomized clinical trials

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.045 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

J Grand ◽

K Miger ◽

A Sajadieh ◽

L Kober ◽

C Torp-Pedersen ◽

...

Keyword(s):

Heart Failure ◽

Composite Endpoint ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Term Outcome ◽

Ventricular Ejection Fraction ◽

Long Term Outcome ◽

All Cause Mortality ◽

Short And Long Term

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background In acute heart failure (AHF), low systolic blood pressure (SBP) has been associated with poor outcome. Less is known of the risk related to normal versus elevated SBP and interaction with left ventricular ejection fraction. Purpose The aim of the present study was to assess the association between baseline SBP and short- and long-term outcome in a large cohort of AHF-patients. Methods A pooled cohort of four randomized controlled trials investigating the vasodilator serelaxin versus placebo in patients admitted with AHF and an SBP from 125 to 180 mmHg. Endpoints were 180-day all-cause mortality and a short-term composite endpoint (worsening heart failure, all-cause mortality or hospital readmission for HF through Day 14). Left ventricular ejection fraction (LVEF) was categorized into HFrEF (<40%) and HFpEF (= >40%). Multivariable Cox regression was used and adjusted for age, sex, baseline body mass index, HFrEF, serum estimated glomerular filtration rate, allocated treatment (placebo/serelaxin), diabetes mellitus, ischemic heart disease, and atrial fibrillation/flutter. Measurements and Main Results A total of 10.533 patients with a mean age of 73 (±12) years and median SBP of 140 (130-150) mmHg were included within mean 8.2 hours from admission. LVEF was assessed in 8493 (81%), and of these, 4294 (51%) had HFrEF. Increasing SBP as a continuous variable was inversely associated with 180-day mortality (HRadjusted: 0.93 [0.88-0.98], p = 0.004 per 10 mmHg increase) and with the composite endpoint (HRadjusted: 0.90 [0.85-0.95], p < 0.0001 per 10 mmHg increase). A significant interaction was observed regarding LVEF, revealing that SBP was not associated with mortality in patients with HFpEF (HRadjusted: 1.01 [0.94-1.09], p = 0.83 per 10 mmHg increase), but SBP was associated with increased mortality in HFrEF (HRadjusted: 0.80 [0.73-0.88], p < 0.001 per 10 mmHg increase) (Figure). Conclusions Elevated SBP is independently associated with favorable short- and long-term outcome in AHF-patients. The association between SBP and mortality was, however, not present in patients with preserved LVEF. Abstract Figure. Survival plots by SBP and LVEF

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Abstract 16668: Long-term Outcomes After Endo-epicardial Catheter Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy

Circulation ◽

10.1161/circ.132.suppl_3.16668 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Erica S Zado ◽

Pasquale Santangeli ◽

Francis E Marchlinski

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Substantial Improvement ◽

Nonischemic Cardiomyopathy ◽

Term Outcome ◽

Long Term Outcome ◽

Linear Ablation ◽

Long Term Follow Up

Introduction: Endo-epicardial catheter ablation of ventricular tachycardia (VT) in patients (pts) with nonischemic cardiomyopathy (NICM) has been reported to have satisfactory results at the short- and mid-term follow-up. We sought to determine the outcomes at the long-term follow-up of endo-epicardial ablation of VT in NICM. Hypothesis: Catheter ablation provides satisfactory long term outcome Methods: We prospectively enrolled 128 pts (age 59±13 years, 116 [91%] males) with NICM who underwent endo-epicardial radiofrequency catheter ablation at our Institution. After substrate mapping, all critical sites for the clinical or induced VT(s), identified with activation, entrainment or pace-mapping, together with late, split and fractionated potentials were targeted with focal and/or linear ablation. The procedural endpoint was noninducibility of sustained monomorphic VT. Pts were followed with ICD interrogation. Results: A total of 108 (73%) pts had idiopathic dilated NICM. The remaining 20 (14%) pts had hypertrophic CM (n=11), suspected inflammatory CM (n=6), or valvular CM (n=3). The mean LV ejection fraction was 33±15%. After a mean follow-up of 19 months (max 97 months), a total of 36 (28%) pts died and 17 (13%) underwent heart transplant. Cumulative survival free from any recurrent VT was 53% (68/128 patients) (Figure A). In the remaining 60 (47%) patients with VT recurrences, catheter ablation still resulted in a significant beneficial clinical impact on VT burden, with 25/60 (42%) having only isolated (1-2) VT episodes over follow-up, and a striking reduction of VT storm in the remaining pts (Figure B). Conclusions: In patients with NICM and VT, endo-epicardial substrate-based ablation is effective in achieving long-term freedom from any VT in 53% of patients, with a substantial improvement in VT burden in many of the remaining patients.

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