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Meta-Analysis
. 2020 Aug;7(4):1430-1441.
doi: 10.1002/ehf2.12689. Epub 2020 Apr 14.

Predicting sustained ventricular arrhythmias in dilated cardiomyopathy: a meta-analysis and systematic review

Arjan Sammani  1 , Elham Kayvanpour  2   3 , Laurens P Bosman  1 , Farbod Sedaghat-Hamedani  2   3 , Tanja Proctor  4 , Weng-Tein Gi  2   3 , Alicia Broezel  2   3 , Katrin Jensen  4 , Hugo A Katus  2   3 , Anneline S J M Te Riele  1 , Benjamin Meder  2   3   5 , Folkert W Asselbergs  1   6   7
Affiliations
Meta-Analysis

Predicting sustained ventricular arrhythmias in dilated cardiomyopathy: a meta-analysis and systematic review

Arjan Sammani et al. ESC Heart Fail. 2020 Aug.

Abstract

Aims: Patients with non-ischaemic dilated cardiomyopathy (DCM) are at increased risk of sudden cardiac death. Identification of patients that may benefit from implantable cardioverter-defibrillator implantation remains challenging. In this study, we aimed to determine predictors of sustained ventricular arrhythmias in patients with DCM.

Methods and results: We searched MEDLINE/Embase for studies describing predictors of sustained ventricular arrhythmias in patients with DCM. Quality and bias were assessed using the Quality in Prognostic Studies tool, articles with high risk of bias in ≥2 areas were excluded. Unadjusted hazard ratios (HRs) of uniformly defined predictors were pooled, while all other predictors were evaluated in a systematic review. We included 55 studies (11 451 patients and 3.7 ± 2.3 years follow-up). Crude annual event rate was 4.5%. Younger age [HR 0.82; 95% CI (0.74-1.00)], hypertension [HR 1.95; 95% CI (1.26-3.00)], prior sustained ventricular arrhythmia [HR 4.15; 95% CI (1.32-13.02)], left ventricular ejection fraction on ultrasound [HR 1.45; 95% CI (1.19-1.78)], left ventricular dilatation (HR 1.10), and presence of late gadolinium enhancement [HR 5.55; 95% CI (4.02-7.67)] were associated with arrhythmic outcome in pooled analyses. Prior non-sustained ventricular arrhythmia and several genotypes [mutations in Phospholamban (PLN), Lamin A/C (LMNA), and Filamin-C (FLNC)] were associated with arrhythmic outcome in non-pooled analyses. Quality of evidence was moderate, and heterogeneity among studies was moderate to high.

Conclusions: In patients with DCM, the annual event rate of sustained ventricular arrhythmias is approximately 4.5%. This risk is considerably higher in younger patients with hypertension, prior (non-)sustained ventricular arrhythmia, decreased left ventricular ejection fraction, left ventricular dilatation, late gadolinium enhancement, and genetic mutations (PLN, LMNA, and FLNC). These results may help determine appropriate candidates for implantable cardioverter-defibrillator implantation.

Keywords: Dilated cardiomyopathy; Implantable cardiac-defibrillator; Prognosis; Risk; Sudden cardiac death.

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Conflict of interest statement

Prof. Dr Asselbergs reports grants from ERA‐CVD EU, during the conduct of the study; Prof. Dr Katus reports personal fees from Novo Nordisk, personal fees from Bayer Vital, personal fees from Astra Zeneca, personal fees from Daiichi Sankyo, outside the submitted work; Dr Kayvanpour, Dr Sedaghat‐Hamedani, Dr Jensen, Dr te Riele, Dr Bosman, Prof. Meder, Mrs Proctor, Ms Broezel, Dr Gi, and Dr Sammani have nothing to disclose.

Figures

Figure 1
Figure 1
Flowchart of search results and selection process.
Figure 2
Figure 2
Quality assessment using Quality in Prognostic Studies tool of 51 articles included in the systematic review and meta‐analysis.
Figure 3
Figure 3
Summary of meta‐analysis. Pooled hazard ratios with 95% CIs are plotted. Results are grouped in ‘Demographics and History', ‘Electrophysiology' and ‘Imaging'. For references and individual study data, see Supporting Information, Data S1 . CI, confidence interval; EPS, electrophysiological study; LGE, late gadolinium enhancement; LVEDD, left ventricular end‐diastolic diameter; LVEDV, left ventricular end‐diastolic volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular end‐systolic volume; NYHA, New York Heart Association; OHCA, out‐of‐hospital cardiac arrest; sVT, sustained ventricular tachycardia; VT, ventricular tachycardia. For reference numbering see supplemental references
Figure 4
Figure 4
Title: Predictors of sustained ventricular arrhythmias in non‐ischaemic DCM. Caption: summarized findings of the systematic review and meta‐analysis. Abbreviations: see text. (Figure 4 is central illustration).
See this image and copyright information in PMC

Comment in

References

    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González‐Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group . 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37: 2129–2200m.
    1. Shun‐Shin MJ, Zheng SL, Cole GD, Howard JP, Whinnett ZI, Francis DP. Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta‐analysis of 8567 patients in the 11 trials. Eur Heart J 2017; 38: 1738–1746. - PMC - PubMed
    1. Priori SG, Blomström‐Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez‐Madrid A, Nikolaou N, Norekvål TM, Spaulding C, van Veldhuisen D, ESC Scientific Document Group . 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2015; 36: 2793–2867.
    1. Køber L, Thune JJ, Nielsen JC, Haarbo J, Videbæk L, Korup E, Jensen G, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp‐Pedersen C, Pehrson S, DANISH Investigators . Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med 2016; 375: 1221–1230. - PubMed
    1. Wolff G, Lin Y, Karathanos A, Brockmeyer M, Wolters S, Nowak B, Fürnkranz A, Makimoto H, Kelm M, Schulze V. Implantable cardioverter/defibrillators for primary prevention in dilated cardiomyopathy post‐DANISH: an updated meta‐analysis and systematic review of randomized controlled trials. Clin Res Cardiol 2017; 106: 501–513. - PubMed

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