Key result
Low mean 24-h systolic blood pressure (HR 0.96; 95% CI 0.93-0.99; P=0.02), high creatinine, low haemoglobin, and older age independently predicted cardiac death and acute decompensated heart failure.
Why the study?
The ability of ambulatory blood pressure monitoring, 2D-echo, and clinical variables to predict cardiac death and acute decompensated heart failure in ischaemic cardiomyopathy patients with ICD was unclear.
Do ambulatory blood pressure monitoring, 2D-echo, and clinical variables predict cardiac death and acute decompensated heart failure in patients with ischaemic cardiomyopathy following ICD implantation?
Cohort (n=180)
Do ambulatory blood pressure monitoring, 2D-echo, and clinical variables predict cardiac death and acute decompensated heart failure in patients with ischaemic cardiomyopathy following ICD implantation?
Hazard Ratio: 0.96 (95% CI 0.93–0.99)
p-value: p=0.02
Ambulatory systolic blood pressure, haemoglobin, creatinine, and age independently predict death and acute decompensated heart failure in patients with ischaemic cardiomyopathy and an ICD, whereas 2D-echo ejection fraction does not.
These predictors may refine post-ICD risk stratification in ischaemic cardiomyopathy; hypothesis-generating and requires prospective validation.
AIMS: Evaluation of ambulatory blood pressure monitoring (ABPM), two-dimensional (2D) echo and clinical variables in predicting cardiac death and acute decompensated heart failure in patients with ischaemic cardiomyopathy and receiving a cardioverter-defibrillator implantation. METHODS AND RESULTS: We studied 180 consecutive patients (169 men) on an out-patient basis, with systolic dysfunction (ejection fraction ≤35%) and previous myocardial infarction. All received a cardioverter defibrillator (ICD) (116 dual chamber, 36 monocameral and 28 biventricular), for primary prevention of sudden death and standard medical therapy for heart failure. Mean follow-up was 11.7 months. Two-dimensional echo was performed just before ICD implantation, ABPM and haematological samples 2 weeks later. Age, ejection fraction, creatinine, haemoglobin concentration, mean 24-h systolic blood pressure, mean 24-h diastolic blood pressure, mean 24-h heart rate, brain natriuretic peptide, QRS duration, % paced beats, ventricular scar, biventricular pacing, sex and diabetes were considered. Cox proportional hazards regression analysis was used to explore the relationship between events. ROC curves were built for each independent variable. Events occurred in 47 patients (26%); 7 deaths for refractory heart failure and 40 hospitalizations for acute decompensated heart failure. Low mean 24-h systolic blood pressure [hazard ratio 0.96, 95% confidence interval (CI) 0.93-0.99, P = 0.02], high creatinine (hazard ratio 1.61, 95% CI 1.06-2.47, P = 0.01), low haemoglobin concentration (hazard ratio 0.81, 95% CI 0.65-0.99, P = 0.04) and older age (hazard ratio 1.04, 95% CI 1.01-1.08, P = 0.02) were independent predictors of events. CONCLUSIONS: Ambulatory systolic blood pressure, haemoglobin, creatinine and age can stratify risk of death and acute decompensated heart failure in patients with ischaemic cardiomyopathy and ICD in whom 2D-echo ejection fraction is not predictive.
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Antonini et al. (2010) conducted a cohort in ischaemic cardiomyopathy following cardioverter-defibrillator implantation (n=180). Low mean 24-h systolic blood pressure was evaluated on Cardiac death and acute decompensated heart failure (HR 0.96, 95% CI 0.93-0.99, p=0.02). Low mean 24-h systolic blood pressure (HR 0.96; 95% CI 0.93-0.99; P=0.02), high creatinine, low haemoglobin, and older age independently predicted cardiac death and acute decompensated heart failure.
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