Key result
Worsening of LVEF was associated with increased mortality (HR 3.59; 95% CI 1.17-11.04), demonstrating that repeating risk stratification improves outcome prediction in ICD patients.
Why the study?
The predictive value of repeating noninvasive risk stratification in patients with an ICD was unknown.
Does repeating noninvasive risk stratification improve prediction of mortality and appropriate ICD shocks in patients with an ICD?
Cohort (n=635)
Yes
Does repeating noninvasive risk stratification improve prediction of mortality and appropriate ICD shocks in patients with an ICD?
Hazard Ratio: 3.59 (95% CI 1.17–11.04)
Repeating noninvasive risk stratification tests, such as LVEF and HRT, within 12 months improves the prediction of mortality and arrhythmic risk in ICD patients.
Repeating noninvasive stratification may enhance arrhythmia prediction in ICD patients; leaves open whether it alters management or outcomes.
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.
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Vandenberk et al. (2020) conducted a cohort in Ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease in ICD patients (n=635). Repeating noninvasive risk stratification (LVEF, PVC, MTWA, HRT) vs. Consistent or baseline test results was evaluated on Mortality (HR 3.59, 95% CI 1.17-11.04). Worsening of LVEF was associated with increased mortality (HR 3.59; 95% CI 1.17-11.04), demonstrating that repeating risk stratification improves outcome prediction in ICD patients.
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