Key result
In patients with dilated cardiomyopathy on optimal medical therapy, NSVT predicted major ventricular arrhythmias only if LVEF >0.35 (HR 5.3; 95% CI 1.59-17.85), but not if LVEF ≤0.35.
Why the study?
Does the presence of NSVT predict major ventricular arrhythmias in patients with idiopathic dilated cardiomyopathy on optimal medical treatment?
Cohort (n=319)
Does the presence of NSVT predict major ventricular arrhythmias in patients with idiopathic dilated cardiomyopathy on optimal medical treatment?
In patients with idiopathic dilated cardiomyopathy on optimal medical therapy, NSVT predicts major ventricular arrhythmias only in those with LVEF > 0.35, but not in those with LVEF <= 0.35.
NSVT may refine arrhythmia risk assessment in DCM with LVEF >0.35; leaves open its value when LVEF ≤0.35.
BACKGROUND: To evaluate the role of nonsustained ventricular tachycardias (NSVT) for the prediction of major ventricular arrhythmias (MVA) in patients with idiopathic dilated cardiomyopathy (DCM) after optimization of medical treatment. METHODS AND RESULTS: Three hundred nineteen consecutive DCM patients were evaluated after adequate stabilization on optimal angiotensin-converting enzyme (ACE) inhibitor (88%) and beta-blocker (82%) therapy. Frequency, length, and rate of NSVT at 24-hour Holter monitoring were analyzed to assess their values in predicting MVA (unexpected sudden death, SVT, ventricular fibrillation, and appropriate implantable cardioverter defibrillator interventions). During follow-up (median 96 months, 1(st)-3(rd) interquartile range 52-130), MVA incidence was low, and not statistically different between patients with and without NSVT (3 and 2 per 100 patient-years, respectively, P = nonsignificant [NS] at log-rank analysis). At multivariable analysis, the number of NSVT was predictive of MVA only if left ventricular ejection fraction (LVEF) was > 0.35 (two NSVT/day vs no NSVT/day: hazard ratio [HR] 5.3, 95% confidence interval [CI] 1.59-17.85 in LVEF > 0.35 vs HR 0.93, 95% CI 0.3-2.81 in LVEF < or = 0.35). Consequently, in patients with LVEF < or = 0.35, MVA incidence rates were similar regardless of NSVT (3.6 and 4.1 patient-years, respectively, in those with and without NSVT, P = NS), while in patients with LVEF > 0.35, MVA incidence (3.1 per 100 patient-years vs 0.9 per 100 patient-years, P = 0.003) was significantly higher when NSVT were present. CONCLUSIONS: After medical stabilization, NSVT did not increase the risk of MVA in patients with DCM and LVEF < or = 0.35. Conversely, the number and length of NSVT runs were significantly related to the occurrence of MVA in the patients with LVEF > 0.35.
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Zecchin et al. (2008) conducted a cohort in Idiopathic dilated cardiomyopathy (DCM) (n=319). Presence of nonsustained ventricular tachycardias (NSVT) vs. Absence of NSVT was evaluated on Major ventricular arrhythmias (unexpected sudden death, SVT, ventricular fibrillation, and appropriate ICD interventions) (p=NS). In patients with dilated cardiomyopathy on optimal medical therapy, NSVT predicted major ventricular arrhythmias only if LVEF >0.35 (HR 5.3; 95% CI 1.59-17.85), but not if LVEF ≤0.35.
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