History of high-intensity exercise (HR 4.7), T-wave inversions ≥V3 (HR 4.7), and greater LV mechanical dispersion (HR 1.4) strongly predicted life-threatening ventricular arrhythmia in AC patients.
Cohort (n=117)
Do clinical, ECG, and cardiac imaging parameters predict first-time life-threatening ventricular arrhythmia in patients with arrhythmogenic cardiomyopathy?
History of high-intensity exercise, T-wave inversions ≥V3, and greater LV mechanical dispersion strongly predict life-threatening ventricular arrhythmias in patients with arrhythmogenic cardiomyopathy, which may guide primary prevention ICD therapy.
Hazard Ratio: 4.7 (95% CI 1.2–17.5)
p-value: p=0.02
This study aimed to identify clinical, electrocardiographic (ECG) and cardiac imaging predictors of first-time life-threatening ventricular arrhythmia in patients with arrhythmogenic cardiomyopathy (AC). The role of clinical, electrocardiographic, and cardiac imaging parameters in risk stratification of patients without ventricular arrhythmia is unclear. We followed consecutive AC probands and mutation-positive family members with no documented ventricular arrhythmia from time of diagnosis to first event. We assessed clinical, electrocardiographic, and cardiac imaging parameters according to Task Force Criteria of 2010 in addition to left ventricular (LV) and strain parameters. High-intensity exercise was defined as >6 metabolic equivalents. We included 117 patients (29% probands, 50% female, age 40 ± 17 years). During 4.2 (interquartile range IQR: 2.4 to 7.4) years of follow-up, 18 (15%) patients experienced life-threatening ventricular arrhythmias. The 1-, 2-, and 5-year incidence was 6%, 9%, and 22%, respectively. History of high-intensity exercise, T-wave inversions ≥V3, and greater LV mechanical dispersion were the strongest risk markers (adjusted hazard ratio HR: 4.7 95% confidence interval (CI): 1.2 to 17.5; p = 0.02, 4.7 95% CI: 1.6 to 13.9; p = 0.005), and 1.4 95% CI: 1.2 to 1.6 by 10-ms increments; p < 0.001, respectively). Median arrhythmia-free survival in patients with all risk factors was 1.2 (95% CI: 0.4 to 1.9) years, compared with an estimated 12.0 (95% CI: 11.5 to 12.5) years in patients without any risk factors. History of high-intensity exercise, electrocardiographic T-wave inversions ≥V3, and greater LV mechanical dispersion were strong predictors of life-threatening ventricular arrhythmia. Patients without any of these risk factors had minimal risk, whereas ≥2 risk factors increased the risk dramatically. This may help to make decisions on primary preventive implantable cardioverter defibrillator (ICD) therapy.
Lie et al. (Fri,) conducted a cohort in Arrhythmogenic Cardiomyopathy (n=117). High-intensity exercise, T-wave inversions ≥V3, and greater LV mechanical dispersion vs. Absence of these risk factors was evaluated on First-time life-threatening ventricular arrhythmia (HR 4.7, 95% CI 1.2-17.5, p=0.02). History of high-intensity exercise (HR 4.7), T-wave inversions ≥V3 (HR 4.7), and greater LV mechanical dispersion (HR 1.4) strongly predicted life-threatening ventricular arrhythmia in AC patients.