Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post-MI patients with ejection fraction over 40% at SCD risk, insights from the PRESERVE EF study

Abstract Funding Acknowledgements Type of funding sources: None. Background Sudden cardiac arrest (SCA) in post myocardial infarction (post-MI) patients with a relatively preserved left ventricular systolic function (LVEF≥40%) has an annual incidence of 1%, in the absence of adequate risk stratification methods and guideline recommendations for primary prevention. In the PRESERVE-EF study we used a two-step SCA risk stratification approach to detect patients at risk for major arrhythmic events. Seven noninvasive risk factors (NIRFs) were extracted from ambulatory electrocardiography (AECG). Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS). Inducible patients received an ICD. Purpose To assess the performance of NIRFs extracted from 24hr AECG, based on the PRESERVE EF criteria, in predicting inducibility. Methods The PRESERVE EF study enrolled 575 patients. Two hundred and four of them had at least one NIRF and an indication for PVS, but 52 of them declined. Finally, 41 out of 152 patients who underwent PVS were inducible. For the present analysis data from these 152 patients (mean age 60 ± 10years, LVEF 49 ± 6%, 89% males) were analyzed. Chi-square test, univariate logistic regression and areas under ROC curves were calculated for the PVS inducibility endpoint. Results Age, male gender and LVEF for the PVS inducible patients group (n = 41) and the noninducible patients group (n = 111) were, respectively: 61 ± 9years vs 59 ± 10years (p = 0.310), 98% vs 86% (p = 0.048), 45 ± 4% vs 51 ± 7% (p < 0.001). Among NIRFs examined, LVEF ≤ 50%, nsVT≥1/24hour and presence of LPs on SAECG presented high and significant Odds Ratios (ORs) for a positive PVS study end point. A simple risk score based on cutoff points of LVEF ≤ 50%, NSVTepisode≥1/24hour and presence of LPs missed only 1 out of the 41 inducible patients and yielded: OR 14.146 (p = 0.01) with a high sensitivity 98% but low specificity 26% for a positive PVS (AUC = 0.65). Conclusion Cut off points of LVEF ≤ 50%, nsVTepisode≥1/24hour and presence of LPs were important predictors of inducibility. A simple risk score based on these predictors achieves high sensitivity but low specificity. The final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.

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Risk Stratification in Hypertrophic Cardiomyopathy

European Cardiology Review ◽

10.15420/ecr.2015.10.01.31 ◽

2015 ◽

Vol 10 (1) ◽

pp. 31 ◽

Cited By ~ 8

Author(s):

Alexandros Klavdios Steriotis ◽

Sanjay Sharma ◽

◽

Keyword(s):

Risk Factors ◽

Hypertrophic Cardiomyopathy ◽

Risk Stratification ◽

Ventricular Arrhythmias ◽

Risk Model ◽

Predictive Accuracy ◽

Young Patients ◽

Left Ventricular ◽

Adverse Event Rate ◽

Icd Implantation

Hypertrophic cardiomyopathy (HCM) is a hereditary primary myocardial disease that is most commonly due to mutations within genes encoding sarcomeric contractile proteins and is characterised by left ventricular hypertrophy in the absence of a cardiac or systemic cause. Although the overall prognosis is relatively good with an annual mortality rate <1 %, the propensity to potentially fatal ventricular arrhythmias is the most feared complication. The identification of patients at risk of arrhythmogenic sudden cardiac death (SCD) is an essential component in disease management. Aborted SCD and malignant ventricular arrhythmias are the most powerful risk factors for SCD and ICD implantation is recommended in such circumstances. The selection of patients who may benefit from ICD therapy for primary prevention purposes is more challenging. The heterogeneous nature of the disease and the variation in trigger factors provides an adequate explanation for the low predictive accuracy of most conventional risk factors in isolation. A new risk model for risk stratification proposed by the European Society of Cardiology HCM outcome group shows promise but requires validation in different cohorts. The ICD is the only effective therapy in preventing SCD for the disease with a relatively low adverse event rate, but most deaths occur in relatively young patients. However, it is also difficult to ignore the complications with the ICD, therefore, the strive to perfect risk stratification in HCM should continue to ensure that only the most high-risk patients receive an ICD.

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Associations of the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay diet with cardiac remodelling in the community: the Framingham Heart Study

British Journal Of Nutrition ◽

10.1017/s0007114521000660 ◽

2021 ◽

pp. 1-9

Author(s):

Maura E. Walker ◽

Adrienne A. O’Donnell ◽

Jayandra J. Himali ◽

Iniya Rajendran ◽

Debora Melo van Lent ◽

...

Keyword(s):

Risk Factors ◽

Systolic Function ◽

Global Longitudinal Strain ◽

Root Diameter ◽

Left Ventricular ◽

Cardiac Remodelling ◽

Lv Function ◽

The Mediterranean ◽

Diet Score ◽

Mind Diet

Abstract Normal cardiac function is directly associated with the maintenance of cerebrovascular health. Whether the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet, designed for the maintenance of neurocognitive health, is associated with cardiac remodelling is unknown. We evaluated 2512 Framingham Offspring Cohort participants who attended the eighth examination cycle and had available dietary and echocardiographic data (mean age 66 years; 55 % women). Using multivariable regression, we related the cumulative MIND diet score (independent variable) to left ventricular (LV) ejection fraction, left atrial emptying fraction, LV mass (LVM), E/e’ ratio (dependent variables; primary), global longitudinal strain, global circumferential strain (GCS), mitral annular plane systolic excursion, longitudinal segmental synchrony, LV hypertrophy and aortic root diameter (secondary). Adjusting for age, sex and energy intake, higher cumulative MIND diet scores were associated with lower values of indices of LV diastolic (E/e’ ratio: logβ = −0·03) and systolic function (GCS: β = −0·04) and with higher values of LVM (logβ = 0·02), all P ≤ 0·01. We observed effect modification by age in the association between the cumulative MIND diet score and GCS. When we further adjusted for clinical risk factors, the associations of the cumulative MIND diet score with GCS in participants ≥66 years (β = −0·06, P = 0·005) and LVM remained significant. In our community-based sample, relations between the cumulative MIND diet score and cardiac remodelling differ among indices of LV structure and function. Our results suggest that favourable associations between a higher cumulative MIND diet score and indices of LV function may be influenced by cardiometabolic and lifestyle risk factors.

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329 Heart failure predictive value of the electric risk score in patients suffering from thalassemia major

European Heart Journal Supplements ◽

10.1093/eurheartj/suab142.054 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Elisa Tomarelli ◽

Federica Moscucci ◽

Anna Annunziata Losardo ◽

Pellegrina Pugliese ◽

Mauro Schina ◽

...

Keyword(s):

Risk Factors ◽

Risk Score ◽

Ventricular Hypertrophy ◽

Chelation Therapy ◽

Iron Chelation ◽

Myocardial Damage ◽

Thalassemia Major ◽

Left Ventricular ◽

P Value ◽

Iron Chelation Therapy

Abstract Aims Complications associated with iron accumulation were highly recurrent in thalassemia patients, who underwent frequent blood transfusions, in particular hemosiderotic cardiomyopathy which could lead to heart failure and arrhythmias. Nowadays, the better iron chelation therapy has improved cardiovascular morbidity in these patients; nevertheless, mild impairment should be seek for and eventually treated. The objective of our study was to evaluate the possibility of using early electrocardiographic markers of myocardial damage and predictors of mortality, such as the Electric Risk Score (ERS). Methods and results 73 patients with thalassemia major were enrolled in this study, which were divided into two groups, with 45 years old as cut off. Anamnestic, clinical, electrocardiographic, and echocardiographic data were collected. From ECG, ERS was obtained. over 45 yrs-old group of pts, in addition to a predictable increase in the prevalence of traditional cardiovascular risk factors and drug intake, an alteration of the QRS-T angle (14[30] vs. −4[28], p value: <0.0001) and an increased prevalence of left ventricular hypertrophy (2.88 ± 0.86 vs. 2.40 ± 0.57 p value: <0.05) were found. In patients taking drugs with possible interactions with the ventricular repolarization phase, there is a slight increase in the QT interval, left ventricular hypertrophy and a reduction in Tpeak-Tend (Table 1). Electrocardiographic values in groups of patients with different age groups who are taking therapies that can affect QT. The echocardiogram revealed an increase in the end-diastolic diameter of the right ventricle (26 ± 3 vs. 28 ± 3 mm, P-value: 0.05) in the group of patients over the age of 45, a decrease in the acceleration time of the pulmonary systolic flow (138 ± 25 vs. 125 ± 13 ms, P-value: 0.04) and TAPSE (25 ± 3 vs. 22 ± 4 mm, P-value: 0.002). Conclusions From the data in our study it emerged that an appropriate iron-chelation therapy is able to effectively counteract the hemosiderotic cardiomyopathy of thalassemic patients so as to detect electro- and echocardiographic anomalies only in patients of more advanced age, a result that we think both the consequence, not so much of iron overload, but of an increase in the prevalence of age- and gender-related cardiovascular risk factors. The initial changes in cardiac electromechanics, which can be assessed with the aforementioned methods, we believe, can become a very early sign of specific myocardial damage. 329 Figure 1Electrical risk score parameters.

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LEFT VENTRICULAR LEAD IMPLANTATION FOR DETECTION OF VENTRICULAR ARRHYTHMIAS IN PATIENT WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR AND LOW R WAVE IN RIGHT VENTRICLE

American Journal of Cardiology Research and Reviews ◽

10.28933/ajcrar-2021-10-1005 ◽

2021 ◽

pp. 17

Author(s):

Keyword(s):

Sudden Cardiac Death ◽

Right Ventricle ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Systolic Function ◽

Left Ventricular ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Ventricular Lead

Dilated cardiomyopathy (DCM) is a disease characterised as left ventricular (LV) or biventricular dilatation with impaired systolic function. Regardless of underlying cause patients with DCM have a propensity to ventricular arrhythmias and sudden cardiac death. Implantable Cardioverter Defibrillator (ICD) implantation for these patients results in significant reduction of sudden cardiac death [1-3]. ICD devices may be limited by right ventricle (RV) sensing dysfunction with low RV sensing amplitude. We present a clinical case of patient with DCM, implanted ICD and low R wave sensing on RV lead.

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Cardiovascular risk assessment by Framingham score pre and post kidney transplant

Brazilian Journal of Transplantation ◽

10.53855/bjt.v19i2.106 ◽

2016 ◽

Vol 19 (2) ◽

pp. 13-17

Author(s):

Marcos Vinicius de Sousa ◽

Nayara Tenório ◽

Carla Feitosa do Valle ◽

Marilda Mazzali

Keyword(s):

Risk Factors ◽

Total Cholesterol ◽

Kidney Transplant ◽

Risk Score ◽

Graft Loss ◽

Left Ventricular ◽

Inclusion Criteria ◽

Kidney Transplants ◽

Post Transplant ◽

Significant Difference

Cardiovascular mortality is the main cause for graft loss after a successful kidney transplant. Purpose: To analyze the risk for cardiovascular events by the Framinghan risk score, pre and 1-year after kidney transplant. Methods: Retrospective study analyzing the transplant Unit database of kidney transplants performed from January 2010 to January 2012. Inclusion criteria: age >18 years old, functioning graft 12 months post-transplant. Exclusion criteria: patient death or graft loss within the first year after transplant. Demographic and laboratory data were collected pre and 12 months post-transplant; the Framinghan risk score was calculated at those points. Pre-transplant echocardiogram was also analyzed. Results: From 230 kidney transplants performed during the studied period, 167 fulfilled the inclusion criteria. Sixty-three were excluded due to death or graft loss (n=29) or insufficient data for analysis. In the majority, the studied group was male (64.6%), mean age of 47.9+11.1 years old and recipients from deceased donor (97%). Echocardiogram showed a 67.5 +6.6% ejection fraction, left ventricular hypertrophy in 98%, with a low incidence of valvar calcification (2.5%). Framinghan score was similar pre and after transplant (16.4+14.9 vs. 18.3 +17.2, p=ns). However, analysis of isolated parameters showed a significant difference pre and after transplant. While pre-transplant risk factors were high blood pressure, lower HDL cholesterol, and active smoking, post-transplant risk factors were the occurrence of diabetes, higher total cholesterol that required anti-hypertensive therapy. Conclusion: the early after transplant results, recovery of renal function, hematocrit and nutritional levels in the body weight gain usually along with impaired metabolic parameters, mainly total cholesterol, triglyceryde and uric acid maintained a similar Framinghan risk score as pre-transplant levels.

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0555: Arrhythmic risk stratification and prognostic value of programmed ventricular stimulation in arrhythmogenic right ventricular cardiomyopathy/dysplasia

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(15)71678-2 ◽

2015 ◽

Vol 7 (1) ◽

pp. 66-67

Author(s):

Carole Maupain ◽

Nicolas Badenco ◽

Guillaume Duthoit ◽

Xavier Waintraub ◽

Thomas Chastre ◽

...

Keyword(s):

Risk Stratification ◽

Right Ventricular ◽

Prognostic Value ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Ventricular Cardiomyopathy ◽

Programmed Ventricular Stimulation ◽

Ventricular Stimulation

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P990Assessment of clinical risk factors for all-cause mortality among hypertrophic cardiomyopathy patients with ICDs

European Heart Journal ◽

10.1093/eurheartj/ehz747.0583 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Mielczarek ◽

P Syska ◽

M Lewandowski ◽

A Przybylski ◽

M Sterlinski ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Family History ◽

Secondary Prevention ◽

Positive Family History ◽

Left Ventricular ◽

Icd Implantation ◽

All Cause Mortality ◽

History Of ◽

End Stage

Abstract Introduction According to the literature, the annual mortality rate of hypertrophic cardiomyopathy (HCM) patients is estimated to 1–2%. Sudden cardiac death (SCD), heart failure and thromboembolism are the main causes of death among this population. Patients at high risk for SCD, identified using HCM risk score, are qualified for ICD implantation. Unfortunately for clinicians, there is no validated model or statistical tool for assessment of the risk of mortality within the HCM patients with ICDs. Purpose The aim of this study was to determine the main risk factors of all- cause mortality in HCM patients with ICDs. Methods The long-term follow-up of group of 104 consecutive patients with HCM, who had the ICD implanted between 1996 and 2006 in tertiary reference clinical unit was performed. Twenty patients who died during observation were the subject of the current analysis. ICD was implanted for primary (n=16) and secondary (n=4) prevention of SCD within this subpopulation. Analysis were performed for mentioned below potential risk factors: age at the time of implantation, syncopes, family history of SCD, atrial fibrillation/supraventricular tachycardia, decreased left ventricular ejection fraction (LVEF), non-sustained ventricular tachycardia (nsVT), maximum left ventricular wall thickness, abnormal exercise blood pressure response, left ventricular outflow tract obstruction. Results The average time of survival since ICD implantation was 8,5±4,6 years. Decreased LVEF (Wald chi2 4,57; p=0,033), secondary prevention (Wald chi2 8,57; p=0,003), family history of SCD (Wald chi2 4,93; p=0,026) and episodes of nsVT (Wald chi2 3,49; p=0,062) are the clinical risk factors that significantly affect the time of survival. The probability of death, expressed as Hazard Ratio, was 27-fold higher in secondary prevention group (HR=27,18), almost 10-fold higher in patients with positive family history of SCD (HR=9,74) and 3,7-fold higher when nsVT was detected. The cause of death was established in 16/20 patients. In 15 cases, these were deaths from cardiovascular causes: end-stage heart failure (8), complications of heart transplantation or circulatory support (4), SCD (1) and other cardiovascular (2). Conclusion Secondary prevention, positive family history of SCD, nsVT and decreased LVEF seem to be the most significant risk factors associated with all- cause mortality in HCM patients with ICDs. Despite the ICD implantation, subpopulation studied had poor prognosis with high incidence of progression to end-stage heart failure. Further studies to create validated model for assessment of death risk in long-term observation of patients with HCM after ICD implantation are required.

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