scholarly journals P1736Two-step risk stratification of life-threatening ventricular tachyarrhythmias in patients with dilated cardiomyopathy

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii377-iii378
Author(s):  
TG. Vaikhanskaya ◽  
VC. Barsukevich ◽  
OP. Melnikova ◽  
AV. Frolov
Keyword(s):  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Ventricular Tachyarrhythmias ◽  
Life Threatening

Arrhythmic risk stratification in non-ischaemic dilated cardiomyopathy beyond ejection fraction

Heart ◽  
2020 ◽  
Vol 106 (9) ◽  
pp. 656-664 ◽  
Author(s):  
Antonio Cannatà ◽  
Giulia De Angelis ◽  
Andrea Boscutti ◽  
Camilla Normand ◽  
Jessica Artico ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Novel Approach ◽  
Magnetic Resonance Parameters ◽  
Reverse Remodelling ◽  
Life Threatening

Sudden cardiac death and arrhythmia-related events in patients with non-ischaemic dilated cardiomyopathy (NICM) have been significantly reduced over the last couple of decades as a result of evidence-based pharmacological and non-pharmacological therapeutic strategies. Nevertheless, the arrhythmic stratification in patients with NICM remains extremely challenging, and the simple indication based on left ventricular ejection fraction appears to be insufficient. Therefore, clinicians need to go beyond the current criteria for implantable cardioverter-defibrillator implantation in the direction of a multiparametric evaluation of arrhythmic risk. Several parameters for arrhythmic risk stratification, ranging from electrocardiographic, echocardiographic, imaging-derived and genetic markers, are crucial for proper arrhythmic risk stratification and a multiparametric evaluation of risk in patients with NICM. In particular, integration of cardiac magnetic resonance parameters (mostly late gadolinium enhancement) and specific genetic information (ie, presence of LMNA, PLN, FLNC mutations) appears fundamental for proper implementation of the current arrhythmic risk stratification. Finally, a novel approach focused on both arrhythmic risk and prediction of left ventricular reverse remodelling during follow-up might be useful for effective multiparametric and dynamic arrhythmic risk stratification in NICM. In the future, a complete and integrated evaluation might be mandatory to implement arrhythmic risk prediction in patients with NICM and to discriminate the competing risk between heart failure-related events and life-threatening arrhythmias.

Risk stratification personalised model for prediction of life-threatening ventricular tachyarrhythmias in patients with chronic heart failure

2017 ◽  
pp. 682-688 ◽  
Author(s):  
Alexander Vladimirovich Frolov ◽  
Tatjana Gennadjevna Vaikhanskaya ◽  
Olga Petrovna Melnikova ◽  
Anatoly Pavlovich Vorobiev ◽  
Ludmila Michajlovna Guel
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Risk Stratification ◽  
Ventricular Tachyarrhythmias ◽  
Life Threatening

scholarly journals Myocardial electrical instability score: clinical and prognostic significance

2019 ◽  
pp. 55-61 ◽  
Author(s):  
A. V. Frolov ◽  
T. G. Vaykhanskaya ◽  
O. P. Melnikova ◽  
A. P. Vorobev ◽  
A. G. Mrochek
Keyword(s):  
Risk Stratification ◽  
Qt Interval ◽  
Prognostic Significance ◽  
Ventricular Tachyarrhythmias ◽  
T Wave ◽  
Fragmented Qrs ◽  
Electrical Instability ◽  
Life Threatening ◽  
Rate Deceleration ◽  
The Individual

Aim. To develop and test a risk-stratification model for patients with coronary artery disease (CAD) and non-ischemic pathologies based on a computer analysis of electrical instability ECG markers.Material and methods. In the period from 2011 to 2018, the study included 1014 patients with CAD and non-ischemic pathologies. Depending on ventricular arrhythmia status, the analyzed cohort was divided into 3 groups: 1) 644 patients without lifethreatening ventricular tachyarrhythmias (-VTA), mean age 51,7±16,1 years; 2) 280 patients with clinically significant ventricular arrhythmias (+csVA): ventricular extrasystoles (VES) >1500/24 h, coupled VES >50/24 h or unstable ventricular tachycardia (uVT), mean age 46,7±14,0 years; 3) 90 patients with life-threatening ventricular tachyarrhythmias (+VTA): persistent VT (pVT), successful cardiopulmonary resuscitation (CPR), appropriate discharges by implanted cardioverter defibrillator (CVD), sudden cardiac death (SCD), mean age 46,8±12,7 years.Using the Intekard 7.3 software, ECG markers of myocardial electrical instability were analyzed: T wave alternation, QT interval and dispersion, fragmented QRS, spatial QRS-T angle, turbulence onset and slope, and heart rate deceleration/acceleration.Results. Statistically significant differences were found between the values of T wave alternation, QT interval, fragmented QRS and QRS-T angle in groups 1 and 3 (-VTA) and (+VTA), p<0,005.Personalized model was formed for predicting the risk of life-threatening VTA (primary endpoints: pVT, appropriate CVD discharges, CPR, SCD) in patients with CAD and non-ischemic pathologies (cardiomyopathy, channelopathy) in 5 years follow-up. Integral score of myocardial electrical instability is proposed as new quantitative parameter for risk stratification (sensitivity 75%, specificity 78%, accuracy 77%).Conclusion. The myocardial electrical instability score provides the individual assessment of the dynamic SCD risk. The Intekard 7.3 software is a simple, economic and accessible ECG tool for arrhythmia monitoring.

scholarly journals Risk stratification in cardiogenic shock: a focus on the available evidence

2021 ◽  
Author(s):  
C. Sciaccaluga ◽  
G. E. Mandoli ◽  
N. Ghionzoli ◽  
F. Anselmi ◽  
C. Sorini Dini ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Cardiogenic Shock ◽  
Clinical Syndrome ◽  
Diagnostic Assessment ◽  
Prognostic Scores ◽  
Current Evidence ◽  
Efficient Resource ◽  
Threatening Condition ◽  
Life Threatening ◽  
Future Direction

AbstractCardiogenic shock is a clinical syndrome which is defined as the presence of primary cardiac disorder that results in hypotension together with signs of organ hypoperfusion in the state of normovolaemia or hypervolaemia. It represents a complex life-threatening condition, characterized by a high mortality rate, that requires urgent diagnostic assessment as well as treatment; therefore, it is of paramount important to advocate for a thorough risk stratification. In fact, the early identification of patients that could benefit the most from more aggressive and invasive approaches could facilitate a more efficient resource allocation. This review attempts to critically analyse the current evidence on prognosis in cardiogenic shock, focusing in particular on clinical, laboratoristic and echocardiographic prognostic parameters. Furthermore, it focuses also on the available prognostic scores, highlighting the strengths and the possible pitfalls. Finally, it provides insights into future direction that could be followed in order to ameliorate risk stratification in this delicate subset of patients.

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