FP625CONTINUOUS ECG MONITORING IN NON-DIABETIC PERITONEAL DIALYSIS PATIENTS MAY IDENTIFY PATIENTS AT INCREASED RISK FOR SUDDEN CARDIAC DEATH

Abstract Background and Aims Chronic kidney disease and especially end stage renal disease are important public health issues with increasing incidence and significant economic burden. Despite advances in peritoneal dialysis (PD), mortality is still high mostly because of cardiovascular morbidity and mortality. The aim of the present study was to identify prognostic risk factors for cardiovascular death in non-diabetic PD patients. Method We performed a prospective study in which we included non-diabetic patients in stable PD programme for at least 6 months. Clinical, biological, heart and carotid ultrasound and arterial stiffness (evaluated through applanation tonometry) parameters were analysed. Independent risk factors for cardiovascular death were identified by logistic regression using IBM SPSS ver. 20.0. Results We included 246 consecutive non-diabetic patients (118F, 128M), mean age 56.3 + 15.7 years (20-85). Mean follow up was 6.5+1.1 years. 36 patients (14.6%) died because of cardiovascular reasons - sudden cardiac death 13 patients, acute coronary syndrome 8 patients, ischemic stroke 8 patients, and heart failure 7 patients. Individuals with cardiovascular death were significantly older (64.6±14.2 vs 54.7±15.5 years, p=0.01), with signs of malnutrition, inflammation and associated anemia - significantly lower total cholesterol (150.2±43.0 vs 194.3±58.2 mg/dl, p=0.002), serum albumin (2.9±0.4 vs 3.5±0.7 g/dl, p=0.002) and hemoglobin (9.7±1.1 vs 10.7±1.4 g/dl, p=0.007) and significantly higher serum fibrinogen (568.7±121.3 vs 509.8±115.0 mg/dl, p=0.04) and C-reactive protein (6.7+1.2 vs 9.5+0.9 mg/l, p=0.02). In univariate analysis risk for cardiovascular death was higher in patients with renal hypertensive disease (OR 4.0, 95%CI 1.4-11.5, p=0.01), iPTH serum level <150 pg/ml (OR 6.6, 95%CI: 2.3-18.9, p<0.001), left ventricular hypertrophy (OR 10.6, 95%CI 2.3-18.9, p=0.001) and diastolic dysfunction (OR 4.0, 95%CI 1.2-14.9, p=0.02). Compared to patients with an iPTH between 150-300 pg/ml, both patients with lower iPTH and also higher iPTH had an increased risk for cardiovascular death (OR=1.6, 95%CI: 1.2-2.0; p<0.001 for iPTH<150 pg/ml, and OR =1.2, 95%CI:1.04-1.34; p=0.01 for iPTH<300 pg/ml). Patients with cardiovascular death had signs of subclinic atherosclerosis- intima-media thickness at carotid level >0.9 mm (OR 4.3, 95%CI 1.1-16.3, p=0.02) and higher pulse wave velocity as a sign of increased arterial stiffness (11.9+2.5 vs 8.6+2.6 m/s, p=0.04). After adjusting for potential confounders, independent predictive factors for cardiovascular death were male gender, calcium-phosphate product>55 mg2/dl2, iPTH<150 pg/ml and peripheral arterial disease (Table 1). Conclusion We found an increased risk for cardiovascular death in non-diabetic PD patients, mostly because of sudden cardiac death. Malnutrition, inflammation, but especially abnormal mineral metabolism (both increased calcium-phosphate product and low bone turnover) were identified as risk factors for cardiovascular death and are potentially treatable risk factors to improve cardiovascular outcome in PD patients. A better understanding of pathogenesis and risk factors for cardiovascular death in PD may help improve patients’ management and thus their long-term survival.

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High Oxalate Concentrations Correlate with Increased Risk for Sudden Cardiac Death in Dialysis Patients

Journal of the American Society of Nephrology ◽

10.1681/asn.2020121793 ◽

2021 ◽

pp. ASN.2020121793

Author(s):

Anja Pfau ◽

Theresa Ermer ◽

Steven Coca ◽

Maria Tio ◽

Bernd Genser ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Kidney Failure ◽

Cardiac Death ◽

Cardiovascular Events ◽

Elevated Serum ◽

Continuous Variable ◽

Cox Proportional Hazards ◽

Dialysis Patients ◽

Increased Risk

Background The clinical significance of accumulating toxic terminal metabolites such as oxalate in kidney failure patients is not well understood. Methods To evaluate serum oxalate concentrations and risk of all-cause mortality and cardiovascular events in a cohort of kidney failure patients requiring chronic dialysis, we performed a post-hoc analysis of the randomized German Diabetes Dialysis Study (4D Study); this study included 1255 European hemodialysis patients with diabetes followed up for a median of 4 years. The results obtained via Cox proportional hazards models were confirmed by competing risk regression and restricted cubic spline modeling in the 4D cohort and validated in a separate cohort of 104 US dialysis patients after a median follow-up of 2.5 years. Results A total of 1108 patients had baseline oxalate measurements, with a median oxalate concentration of 42.4 µM. During follow-up, 548 died, including 139 (25.4%) from sudden cardiac death. A total of 413 patients reached the primary composite cardiovascular endpoint (cardiac death, nonfatal myocardial infarction, and fatal or nonfatal stroke). Patients in the highest oxalate quartile (≥59.7 µM) had a 40% increased risk for cardiovascular events (adjusted hazard ratio [aHR], 1.40; 95% confidence interval [95% CI], 1.08 to 1.81) and a 62% increased risk of sudden cardiac death (aHR, 1.62; 95% CI, 1.03 to 2.56), compared with those in the lowest quartile (≤29.6 µM). The associations remained when accounting for competing risks and with oxalate as a continuous variable. Conclusions Elevated serum oxalate is a novel risk factor for cardiovascular events and sudden cardiac death in dialysis patients. Further studies are warranted to test whether oxalate-lowering strategies improve cardiovascular mortality in dialysis patients.

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Long-term Non-Invasive ECG-based Risk Stratification of Sudden Cardiac Death: Extended 5-year Results

International Cardiovascular Forum Journal ◽

10.17987/icfj.v11i0.393 ◽

2017 ◽

Vol 11 ◽

Author(s):

Elena Okisheva ◽

Dmitry Tsaregorodtsev ◽

Vitaly Sulimov

Keyword(s):

Sudden Cardiac Death ◽

Risk Stratification ◽

Predictive Value ◽

Cardiac Death ◽

Ecg Monitoring ◽

Non Invasive ◽

Increased Risk ◽

All Cause Mortality ◽

High Negative Predictive Value

Objectives: To evaluate predictive value of heart rate turbulence (HRT), deceleration capacity (DC) and microvolt T-wave alternans (mTWA) for risk stratification for sudden cardiac death (SCD) in patients after myocardial infarction (MI) during 60 months of follow-up.Methods: We studied 111 patients after MI occurred > 60 days (27 [9; 84] months) before enrollment (84 men; mean age 64.1±10.5 years). All subjects had 24-hour ambulatory ECG monitoring with HRT, DC and mTWA evaluation. Follow-up period was 60 months; primary endpoint was SCD, secondary endpoint included all non-sudden cardiovascular deaths.Results: During follow-up, we registered 19 cases of SCD and 11 cases of non-sudden cardiovascular deaths (including 7 fatal MI and 3 fatal strokes). DC had high negative predictive value (97.4% for all-cause mortality and 93.7% for SCD). DC values below 4.15 for all-cause mortality and 2.0 for SCD significantly increased risk of all-cause mortality (OR 8.5, 95% CI 2.9 to 24.6, р<0.001) и SCD (OR 9.6, 95% CI 3.2 to 28.5, р<0.001). Combined risk assessment at 12 months revealed that the most significant combination was HRT2 and mTWA100 > 53 mcV, which increased risk both of all-cause mortality (30.7-fold) and SCD (63.3-fold); however, at 60 months this predictive value for SCD decreased (OR = 20.8 (95% CI 2.8 to 114.0), p <0.001).Conclusion: Evaluation of HRT, DC and mTWA during 24-hour ECG monitoring may define the high risk of cardiovascular mortality and SCD in post-MI patients especially during the first 12 months after the baseline examination.

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Telemedicine-based early rule out and followup ECG algorithm for COVID-19 patients

EP Europace ◽

10.1093/europace/euab116.518 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

OE Turan ◽

RY Yilancioglu ◽

C Alak ◽

AA Baskurt ◽

B Hunuk ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Retrospective Cohort ◽

Care Group ◽

Ecg Monitoring ◽

Funding Sources ◽

Increased Risk ◽

Rule Out ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Drugs with the potential to prolong QT are used in the treatment of coronavirus 19 (COVID-19) pneumonia. We have developed a telemedicine-based corrected QT (QTc) follow-up algorithm that allows early rule out for follow up. Aims In this study, we investigated the availability and safety of the algorithm. Study design Retrospective cohort Methods Consecutive patients; administered hydroxychloroquine (HCQ) for COVID-19 pneumonia were enrolled into digital ECG recording program which includes QTc follow-up algorithm. Results Patients were classified into three groups as those, excluded promptly from the QTc follow-up based on two consecutive ECG findings (early rule out, n = 92) and those, for whom the follow-up was continued (n = 12) and usual care group (n = 68). Of note, 237 ECG tracings were performed in our algorithm population contrary to standard practice of daily recommended ECG monitoring which could have yielded 975 ECG tracings along with accompanied risks of exposure. This way; we ended in 738 (75.7%) fewer ECG tracings. Sustained ventricular arrhythmia or sudden cardiac death was not observed in the entire patient population. Conclusions It is safe to rely on telemedicine-based early rule out algorithm in COVID-19 patients, receiving hydroxychloroquine treatment. This algorithm abolished the need for further ECG in majority of patients without increased risk during follow up. These algorithms can significantly reduce the healthcare worker exposures by eliminating the need for ECG follow-up promptly. Abstract Figure. Covid-19 Follow up Algorithm

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Association between digoxin use and sudden cardiac death in individuals with the rs10494366 variant of the NOS1AP gene

European Heart Journal ◽

10.1093/ehjci/ehaa946.3394 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Soroush ◽

A Aarnoudse ◽

F Shokri ◽

M Van Den Berg ◽

F Ahmadizar ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Smoking Status ◽

Adaptor Protein ◽

Therapeutic Window ◽

P Value ◽

Qtc Interval ◽

Total Study Population ◽

Increased Risk

Abstract Background Digoxin is one of the oldest cardiovascular medications still used to treat heart failure and atrial fibrillation. Due to its narrow therapeutic window, it is associated with life threatening intoxication and arrhythmias, and with QTc-shortening. Common genetic variation in the nitric oxide synthase-1 adaptor protein (NOS1AP) has been associated with QTc interval prolongation. Purpose We investigated whether the rs10494366 variant of the NOS1AP gene modified the risk of SCD in patients using digoxin. Methods In a prospective population-based cohort study, we included data of the three cohorts, started as of January 1st, 1991 until January 1st 2014. Digoxin current use on the date of cardiac death in cases and the same day of follow-up in the remainder of the cohort was a time-dependent exposure. The main outcome was SCD defined as sudden and unexpected death as a result of cardiac causes, according to international criteria. Identification and adjudication of SCD was performed independently, before the start of this study. We used Cox proportional hazard regression analysis to investigate the associations between NOS1AP rs10494366 variant and incident SCD among digoxin users compared to non-users. Associations were adjusted for age, sex (model 1) in addition to BMI, prevalent diabetes, myocardial infarction, baseline hypertension and smoking status (past, current, never) (model 2). Results We included 14,594 individuals, with a mean age of 65.3 (SD 10.3) years. Almost 59% were female. The cumulative incidence of SCD was 9.5% (609 cases) by the end of follow up. Among them, 98 (16%) individuals were exposed to digoxin at the time of death. In model 1, NOS1AP rs10494366 variant was not associated with SCD in the total study population. However, an interaction term of the gene with the daily dose of digoxin was significantly associated with increased risk of SCD (p-value 0.0001). In model 2, the risk of SCD in current users of digoxin was 4.2 [95% CI 1.3–13.8] for the GG genotype; 2.1 [95% CI 1.1–4.2] for the GT genotype, and 1.5 [95% CI 0.7–3.2] for the TT genotype. Conclusion NOS1AP rs10494366 variant modified the risk of sudden cardiac death in users of digoxin. Our study suggests that individuals with the homozygous minor GG allele have a fourfold increased risk of sudden cardiac death. Funding Acknowledgement Type of funding source: None

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N-terminal pro-brain natriuretic peptide and sudden cardiac death in hypertrophic cardiomyopathy

Heart ◽

10.1136/heartjnl-2020-317701 ◽

2020 ◽

pp. heartjnl-2020-317701

Author(s):

Guixin Wu ◽

Jie Liu ◽

Shuiyun Wang ◽

Shiqin Yu ◽

Ce Zhang ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Sudden Cardiac Death ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Cardiac Death ◽

Cardiac Fibrosis ◽

Discrimination Performance ◽

Net Reclassification Improvement ◽

C Statistic ◽

Increased Risk

ObjectiveElevated levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with heart failure-related death in hypertrophic cardiomyopathy (HCM), but the relationship between NT-proBNP level and sudden cardiac death (SCD) in HCM remains undefined.MethodsThe study prospectively enrolled 977 unrelated patients with HCM with available NT-proBNP results who were prospectively enrolled and followed for 3.0±2.1 years. The Harrell’s C-statistic under the receiver operating characteristic curve was calculated to evaluate discrimination performance. A combination model was constructed by adding NT-proBNP tertiles to the HCM Risk-SCD model. The correlation between log NT-proBNP level and cardiac fibrosis as measured by late gadolinium enhancement (LGE) or Masson’s staining was analysed.ResultsDuring follow-up, 29 patients had SCD. Increased log NT-proBNP levels were associated with an increased risk of SCD events (adjusted HR 22.27, 95% CI 10.93 to 65.63, p<0.001). The C-statistic of NT-proBNP in predicting SCD events was 0.80 (p<0.001). The combined model significantly improved the predictive efficiency of the HCM Risk-SCD model from 0.72 to 0.81 (p<0.05), with a relative integrated discrimination improvement of 0.002 (p<0.001) and net reclassification improvement of 0.67 (p<0.001). Furthermore, log NT-proBNP levels were significantly correlated with cardiac fibrosis as detected either by LGE (r=0.257, p<0.001) or by Masson’s trichrome staining in the myocardium (r=0.198, p<0.05).ConclusionNT-proBNP is an independent predictor of SCD in patients with HCM and may help with risk stratification of this disease.

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Expect the Unexpected: Sudden Cardiac Death in Dialysis Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.12131111 ◽

2011 ◽

Vol 7 (1) ◽

pp. 8-11 ◽

Cited By ~ 3

Author(s):

Rulan S. Parekh

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Dialysis Patients

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Vital exhaustion and sudden cardiac death in the Atherosclerosis Risk in Communities Study

Heart ◽

10.1136/heartjnl-2017-311825 ◽

2017 ◽

Vol 104 (5) ◽

pp. 423-429 ◽

Cited By ~ 2

Author(s):

Brittany M Bogle ◽

Nona Sotoodehnia ◽

Anna M Kucharska-Newton ◽

Wayne D Rosamond

Keyword(s):

Risk Factors ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Disease Risk ◽

Ventricular Tachyarrhythmia ◽

Atherosclerosis Risk In Communities ◽

Vital Exhaustion ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Aric Study

ObjectiveVital exhaustion (VE), a construct defined as lack of energy, increased fatigue and irritability, and feelings of demoralisation, has been associated with cardiovascular events. We sought to examine the relation between VE and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) Study.MethodsThe ARIC Study is a predominately biracial cohort of men and women, aged 45–64 at baseline, initiated in 1987 through random sampling in four US communities. VE was measured using the Maastricht questionnaire between 1990 and 1992 among 13 923 individuals. Cox proportional hazards models were used to examine the hazard of out-of-hospital SCD across tertiles of VE scores.ResultsThrough 2012, 457 SCD cases, defined as a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual, were identified in ARIC by physician record review. Adjusting for age, sex and race/centre, participants in the highest VE tertile had an increased risk of SCD (HR 1.48, 95% CI 1.17 to 1.87), but these findings did not remain significant after adjustment for established cardiovascular disease risk factors (HR 0.94, 95% CI 0.73 to 1.20).ConclusionsAmong participants of the ARIC study, VE was not associated with an increased risk for SCD after adjustment for cardiovascular risk factors.

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Arrhythmias in dialysis patients

In a good rythm ◽

10.5604/01.3001.0014.7471 ◽

2021 ◽

Vol 4 (57) ◽

pp. 8-11

Author(s):

Szymon Warwas ◽

Marta Jagosz ◽

Beata Średniawa ◽

Michał Mazurek ◽

Ewa Jędrzejczyk-Patej

Keyword(s):

Cardiovascular Diseases ◽

Sudden Cardiac Death ◽

Kidney Disease ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Dialysis Patients ◽

End Stage Kidney Disease ◽

Common Cause ◽

Conduction Disturbances ◽

End Stage

The most common cause of death among dialysis patients with end-stage kidney disease are cardiovascular diseases. It is estimated that 18-27% of all deaths in dialysis patients are sudden cardiac deaths due to arrhythmias and conduction disturbances. The most common arrhythmias in dialysis patients, often leading to sudden death, are not ventricular arrhythmias but bradyarrhythmias. The article below discusses the most common arrhythmias in dialysis patients and methods of preventing sudden cardiac death in this group of patients.

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Abstract 2415: Long-Term Baroreflex Activation Therapy Increases the Threshold for the Induction of Lethal Ventricular Arrhythmias in Dogs with Chronic Advanced Heart Failure

Circulation ◽

10.1161/circ.118.suppl_18.s_722 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Mengjun Wang ◽

Valerio Zaca ◽

Alice Jiang ◽

Itamar Ilsar ◽

Matthew Ebinger ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Ventricular Arrhythmias ◽

Lv Function ◽

Baroreflex Activation Therapy ◽

Increased Risk ◽

Lv Remodeling ◽

Activation Therapy

Heart failure (HF) is associated with a high incidence of ventricular tachycardia (VT) and fibrillation (VF). Patients with HF in whom these lethal arrhythmias can be induced by electrophysiological (EP) testing carry a high risk of sudden cardiac death. We showed that chronic electrical carotid baroreflex activation therapy (BAT) with the Rheos® System (CVRx, Inc.) improves LV function, attenuates LV remodeling and restores autonomic sympathetic-parasympathetic balance in dogs with HF. This study examined the effects of long-term therapy with BAT on the induction of VT or VF in dogs with coronary microembolization-induced HF (LV ejection fraction ~20%). Eleven dogs with HF underwent EP testing at baseline prior to therapy and after 3 and 6 months of therapy with BAT and again 6 weeks after withdrawal of BAT therapy (n = 7) or no therapy at all (Control, n = 4). Programmed ventricular stimulation was performed from the right ventricular apex and included delivery of up to 4 extrastimuli at progressively shorter coupling intervals (in steps of 10 msec). The extrastimuli were delivered following 8 ventricular paced beats with a drive cycle length between 600 and 200 msec. If a sustained monomorphic VT or VF could not be induced, isoproterenol infusion was initiated to increase the sinus rate by ~30% and the EP stimulation protocol was repeated. At baseline, a sustained VT or VF was induced in all 11 dogs (100%). After 3 and 6 months of follow-up, all Control dogs (100%) were induced into sustained VT or VF. After 3 months of BAT, only 3 of 7 dogs (43%) were induced into sustained VT or VF. After 6 months of BAT, only 2 of 7 dogs (29%) were induced into sustained VT or VF. Finally after withdrawal of BAT therapy, all dogs (100%) were again induced into systained VT or VF. In addition to improving LV function and attenuating LV remodeling, long-term monotherapy with BAT markedly increases the threshold for lethal ventricular arrhythmias in dogs with chronic HF. This is a marked improvement over inducibility of lethal arrhythmias seen in historical untreated controls. This benefit of BAT supports the continued exploration of this device as a therapeutic modality for treating patients with chronic HF and increased risk of sudden cardiac death.

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