scholarly journals Ventricular tachyarrhythmias prediction in patients with coronary artery disease and left ventricular dysfunction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Atabekov ◽  
R Batalov ◽  
S Krivolapov ◽  
M Khlynin ◽  
S Sazonova ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Standard Deviation ◽  
Frequency Domain ◽  
Ventricular Arrhythmias ◽  
Roc Analysis ◽  
Low Frequency ◽  
Left Ventricular ◽  
Icd Implantation ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. The cardioverter-defibrillator (ICD) implantation is the most effective method for the sudden cardiac death (SCD) prevention. However, about 25% patients didn"t have an incidence of ICD shocks during first battery life. Most of them are mainly represented by patients who had the ICD implanted for the primary prevention of the SCD. It us known, reduced left ventricular ejection fraction (LVEF) is an independent predictor of the SCD. So, it’s necessary to find out new predictors of the SCD and ventricular arrhythmias (VTA) incidence, which will help to optimize the selection of patients who really need a ICD implantation. Purpose. To identify predicting methods of the VTA in patients with coronary artery disease and LVEF 35% or less. Materials and methods. The study included 40 patients (males – 36, mean age – 63,4 ± 7,8 years) with coronary artery disease (CAD), LVEF 35% or less and ICD implantation indications (primary prevention of the SCD). Patients before ICD implantation underwent 6-minute walk test, echocardiography, heart rate variability analysis and cardiac single-photon emission computed tomography with 123I-meta-iodobenzylguanidine (123I-MIBG). All patients after ICD implantation were followed-up during two years and divided into two groups. Results. The 1-st group consisted of 36 (90,0%) patients with VTA events. The 2-nd group consisted of 4 (10,0%) patients without VTA events. The univariate ROC-analysis showed that the low values of the average NN intervals (AUC = 0,986, p = 0,0001, t ≤ 1211 ms), standard deviation of NN intervals (AUC = 0,986, p = 0,0001, t ≤ 119 ms), standard deviation of the average NN intervals (AUC = 0,861, p = 0,0001, t ≤ 94 ms), average standard deviation of NN intervals (AUC = 0,792, p = 0,004, t ≤ 48 ms), root mean square of successive differences (AUC = 0,847, p = 0,0003, t ≤ 18 ms), very low frequency domain (AUC = 0,792, p = 0,02, t ≤ 2411 ms), low frequency domain (LFD) (AUC = 0,903, p = 0,0001, t ≤ 1046 ms), high frequency domain (AUC = 0,875, p = 0,0001, t ≤ 743 ms), total frequency domains (AUC = 0,847, p = 0,0003, t ≤ 2785 ms), heart/mediastinum ratio on early (AUC = 0,889, p = 0,0001, t ≤ 2,29) and delayed (AUC = 0,806, p = 0,001, t ≤ 1,65) scintigrams, as well as high values of the end-diastolic index (AUC = 0,944, p = 0,0001, t > 65,9 ml/m2), end-systolic index (AUC = 1,000, p = 0,0001, t > 23,6 мл/м2), 123I-MIBG accumulation defect on early (AUC = 0,958, p = 0,0001, t > 15,0%) and delayed (AUC = 0,958, p = 0,0001, t > 18,0%) scintigrams leaded to frequent occurrences of the VTA. The multivariate ROC-analysis demonstrated that the LFD (p = 0,0136) is independent predictor of the VTA. Also, increase of the VTA predictive ratio, calculated according to this predictive model, more than 0,8936 leaded to frequent occurrences of the VTA (AUC = 0,903, p = 0,0001). Conclusion. A decrease in the LFD can be a predictor of the VTA in patients with CAD. An increase in the predictive ratio more than 0,8936 is a prognostic marker of the life-threatening ventricular arrhythmias.

scholarly journals New biochemical predictor of the ventricular tachyarrhythmias in patients with ischemic cardiomyopathy

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Atabekov ◽  
R Batalov ◽  
S Sazonova ◽  
S Gusakova ◽  
S Krivolapov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Ischemic Cardiomyopathy ◽  
Roc Analysis ◽  
Ventricular Tachyarrhythmias ◽  
Icd Implantation ◽  
Galectin 3 ◽  
Artery Disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. The cardioverter-defibrillator (ICD) implantation is the most effective method for the sudden cardiac death (SCD) prevention. However, about 25% patients did not receive an ICD therapy during the first 5-years follow-up. At the same time ICD does not register ventricular tachyarrhythmias (VTA) events in patients with ICD implanted for the primary prevention of SCD. So, it’s necessary to find out new prognostic markers of the VTA incidence, which will help to optimize the selection of patients who really need an ICD implantation. Currently, ST-2 and galectin-3 are actively studied in patients with coronary artery disease (CAD) and chronic heart failure due to their high potential prognostic value. Moreover, their role in the development of life-threatening arrhythmias is still poorly understood. In this regard, the study of the level of biomarkers of inflammation and myocardial fibrosis is relevant. Aim. To evaluate the prognostic value of the ST-2 and galectin-3 in VTA predicting in patients with coronary artery disease and left ventricular ejection fraction less than 35 %. Material and methods. The study included 40 patients (males – 36, median age – 64,5 [57,5; 68,5] years) with CAD, II and III functional class of chronic heart failure, left ventricle ejection fraction less than 35 % and ICD implantation indications (primary prevention of the SCD). ST-2 and galectin-3 blood concentration were determined before ICD implantation. All patients were followed-up during 18 months. There were assessed arrhythmological events recorded in ICD memory and ICD-lead parameters. Results. The 1st group consisted of 10 (25,0 %) patients with VTA events terminated with ICD antitachycardia pacing or shock, the 2nd group – 30 (75,0 %) patients without VTA events. The univariate ROC-analysis showed that the high values of the ST-2 (p = 0,003) and galectin-3 (p = 0,045) were associated with frequent VTA events. Kaplan-Meier analysis showed that the ST-2 > 22,48 ng/ml (p = 0,02) and galectin-3 > 10,95 ng/ml (p = 0,009) significantly increase the risk of the VTA events. The multivariate ROC-analysis showed that only ST-2 increase (OR = 1,1053; CI 95 %: 1,0134-1,2056; р = 0,023) leaded to frequent VTA events. Conclusion. An increase of ST-2 more than 22,48 ng/ml and galectin-3 more than 10,95 ng/ml has predictive value in VTA assessing risk in patients with ischemic cardiomyopathy. In multivariate analysis, an independent predictor of VTA is the ST-2 increase more than 22,48 ng/ml.

scholarly journals Algorithm for the management of patients with stable coronary artery disease and high-grade ventricular arrhythmias

2017 ◽  
Vol 89 (1) ◽  
pp. 94-102 ◽  
Author(s):  
Е А Ryngach ◽  
T V Treshkur ◽  
A A Tatarinova ◽  
E V Shlyakhto
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ventricular Arrhythmias ◽  
Systolic Function ◽  
Stable Coronary Artery Disease ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
High Grade ◽  
Original Algorithm ◽  
Artery Disease

The paper gives an original algorithm for the management of patients with stable coronary artery disease, preserved/moderately reduced left ventricular systolic function, and high-grade ventricular arrhythmias from the first registration of the latter to the choice of treatment policy. Great attention is paid to the assessment of a private clinical case, by determining the nature of arrhythmias, and to the involvement of autonomic regulation in the genesis of ventricular arrhythmias. The importance of topical diagnosis of ventricular arrhythmias and identification of psychological disorders is emphasized. Diagnostic problems are solved in a step-by-step fashion using up-to-date techniques. The key point of the algorithm proposed is to prevent sudden cardiac death.

scholarly journals Reversible Cause of Cardiac Arrest and Secondary Prevention Implantable Cardioverter Defibrillators in Patients With Coronary Artery Disease: Value of Complete Revascularization and LGE‐CMR

2021 ◽  
Author(s):  
Anne‐Lotte C. J. van der Lingen ◽  
Marthe A. J. Becker ◽  
Michiel J. B. Kemme ◽  
Mischa T. Rijnierse ◽  
Eva M. Spoormans ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Arrest ◽  
Coronary Artery ◽  
Sudden Cardiac Arrest ◽  
Left Ventricular ◽  
Complete Revascularization ◽  
Gadolinium Enhancement ◽  
Icd Implantation ◽  
Off Label ◽  
Artery Disease

Background In survivors of sudden cardiac arrest with obstructive coronary artery disease, it remains challenging to distinguish ischemia as a reversible cause from irreversible scar‐related ventricular arrhythmias. We aimed to evaluate the value of implantable cardioverter‐defibrillator (ICD) implantation in sudden cardiac arrest survivors with presumably reversible ischemia and complete revascularization. Methods and Results This multicenter retrospective cohort study included 276 patients (80% men, age 67±10 years) receiving ICD implantation for secondary prevention. Angiography was performed before ICD implantation. A subgroup of 166 (60%) patients underwent cardiac magnetic resonance imaging with late gadolinium enhancement before implantation. Patients were divided in 2 groups, (1) ICD‐per‐guideline, including 228 patients with incomplete revascularization or left ventricular ejection fraction ≤35%, and (2) ICD‐off‐label, including 48 patients with complete revascularization and left ventricular ejection fraction >35%. The primary outcome was time to appropriate device therapy (ADT). During 4.0 years (interquartile range, 3.5–4.6) of follow‐up, ADT developed in 15% of the ICD‐off‐label group versus 43% of the ICD‐per‐guideline group. Time to ADT was comparable in the ICD‐off‐label and ICD‐per‐guideline groups (hazard ratio (HR), 0.46; P =0.08). No difference in mortality was observed (HR, 0.95; P =0.93). Independent predictors of ADT included age (HR, 1.03; P =0.01), left ventricular end‐diastolic volume HR, (1.05 per 10 mL increase; P <0.01) and extent of transmural late gadolinium enhancement (HR, 1.12; P =0.04). Conclusions This study demonstrates that sudden cardiac arrest survivors with coronary artery disease remain at high risk of recurrent ventricular arrhythmia, even after complete revascularization and with preserved left ventricular function. Late gadolinium enhancement–cardiac magnetic resonance imaging derived left ventricular volumes and extent of myocardial scar were independently associated with.

Sign in / Sign up

Export Citation Format

Share Document