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Multicenter Study
. 2020 Nov;25(6):e12794.
doi: 10.1111/anec.12794. Epub 2020 Aug 17.

Repeating noninvasive risk stratification improves prediction of outcome in ICD patients

Bert Vandenberk  1   2 , Vincent Floré  1 , Christian Röver  3 , Mark A Vos  4 , Albert Dunnink  4 , Dionyssios Leftheriotis  5 , Tim Friede  3 , Panagiota Flevari  5 , Markus Zabel  6 , Rik Willems  1   2
Affiliations
Multicenter Study

Repeating noninvasive risk stratification improves prediction of outcome in ICD patients

Bert Vandenberk et al. Ann Noninvasive Electrocardiol. 2020 Nov.

Abstract

Background: Noninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter-defibrillator (ICD).

Methods: The EUTrigTreat clinical study was a prospective multicenter trial including ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease. Left ventricular ejection fraction ≤40% (LVEF), premature ventricular complexes >400/24 hr (PVC), non-negative microvolt T-wave alternans (MTWA), and abnormal heart rate turbulence (HRT) were considered high risk. Tests were repeated within 12 months after inclusion. Adjusted Cox regression analysis was performed for mortality and appropriate ICD shocks.

Results: In total, 635 patients had analyzable baseline data with a median follow-up of 4.4 years. Worsening of LVEF was associated with increased mortality (HR 3.59, 95% CI 1.17-11.04), as was consistent abnormal HRT (HR 8.34, 95%CI 1.06-65.54). HRT improvement was associated with improved survival when compared to consistent abnormal HRT (HR 0.10, 95%CI 0.01-0.82). For appropriate ICD shocks, a non-negative MTWA test or high PVC count at any moment was associated with increased arrhythmic risk independent of the evolution of test results (worsening: HR 3.76 (95%CI 1.43-9.88) and HR 2.50 (95%CI 1.15-5.46); improvement: HR 2.80 (95%CI 1.03-7.61) and HR 2.45 (95%CI 1.07-5.62); consistent: HR 2.47 (95%CI 0.95-6.45) and HR 2.40 (95%CI 1.33-4.33), respectively). LVEF improvement was associated with a lower arrhythmic risk (HR 0.34, 95%CI 0.12-0.94).

Conclusions: Repeating LVEF and HRT improved the prediction of mortality, whereas stratification of ventricular arrhythmias may be improved by repeating LVEF measurements, MTWA and ECG Holter monitoring.

Keywords: autonomic function; heart rate turbulence; left ventricular ejection fraction; microvolt T-wave alternans; noninvasive risk stratification; sudden cardiac death.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier analysis for mortality
FIGURE 2
FIGURE 2
Kaplan–Meier analysis for appropriate ICD shocks
See this image and copyright information in PMC

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