Key result
Frequent premature ventricular contractions and severely reduced left ventricular ejection fraction (<30%) were strong independent predictors of major cardiovascular events in patients with compensated heart failure with reduced ejection fraction.
Why the study?
Ventricular arrhythmias cause significant sudden deaths and have high prevalence in heart failure, but the prevalence and prognostic correlation of silent ventricular arrhythmias in ambulatory HFrEF patients remained to be determined.
Does the presence of silent ventricular arrhythmias predict major adverse cardiovascular events in ambulatory HFrEF patients?
Cohort (n=400)
No
Does the presence of silent ventricular arrhythmias predict major adverse cardiovascular events in ambulatory HFrEF patients?
Absolute Event Rate: 83.7% vs 55.6%
p-value: p=<0.001
In ambulatory patients with HFrEF, silent ventricular arrhythmias are highly prevalent and, along with severely reduced LVEF, strongly predict major adverse cardiovascular events at 1 year.
Supports arrhythmia surveillance in compensated HFrEF; leaves open whether suppressing frequent PVCs improves outcomes.
BACKGROUND: Ventricular arrhythmias cause a significant proportion of sudden deaths. Several studies demonstrate a high prevalence of ventricular arrhythmias in patients with heart failure regardless of the etiology. The aim of this study was to determine the prevalence of silent ventricular arrhythmias in ambulatory heart failure patients with reduced left ventricular ejection fraction (HFrEF) and its correlation to the prognosis. RESULTS: Four hundred (400) ambulatory HFrEF patients on maximum tolerated doses of heart failure medications were included. Holter monitoring for 7 days was done in all patients searching for silent ventricular arrhythmias. The patients were followed-up for one year to detect the occurrence of major adverse cardiovascular events. We divided the study population into 2 groups based on an LVEF cutoff value of 30% (Group A < 30%, Group B ≥ 30%). Holter monitoring revealed ventricular arrhythmias in 304 patients. Patients with left ventricular ejection fraction (EF) < 30% (Group A) had more complex ventricular arrhythmias in the form of frequent Premature ventricular contractions (PVCs) of ≥ 5% and or non-sustained ventricular tachycardia (NSVT) runs. Furthermore, Among Group A, more major cardiovascular events were observed. Multivariate regression analysis showed that frequent PVCs and severely reduced LVEF were the strongest independent predictors of major cardiovascular events. CONCLUSIONS: ventricular arrhythmias are common in HFrEF patients even in the compensated status. Both, left ventricular systolic function and the PVCs burden were found to be the strongest predictors of major adverse cardiovascular events.
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Sanhoury et al. (2022) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=400). Frequent premature ventricular contractions (≥ 5% or NSVT) vs. Infrequent premature ventricular contractions (< 5%) was evaluated on Major cardiovascular events (death, heart failure hospitalization, or sustained ventricular tachycardia) (p=<0.001). Frequent premature ventricular contractions and severely reduced left ventricular ejection fraction (<30%) were strong independent predictors of major cardiovascular events in patients with compensated heart failure with reduced ejection fraction.
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