Prognostic impact of left ventricular ejection fraction in patients with electrical storm
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The study sought to assess retrospectively the prognostic impact of left ventricular ejection fraction (LVEF) in patients with electrical storm (ES).
Data regarding the prognostic impact of impaired LVEF in ES patients is rare.
Consecutive patients presenting with ES from 2002 to 2016 were included retrospectively. Patients with LVEF ≤ 35% were compared to patients with LVEF > 35%. The primary prognostic endpoint was long-term all-cause mortality, and secondary endpoints were rates of in-hospital mortality, rehospitalization, major adverse cardiac events (MACE), and ES recurrences (ES-R) at long-term follow-up.
A total of 80 patients with ES were included at 2.5 years of follow-up. 69% of patients suffered from LVEF ≤ 35%. ES patients with LVEF ≤ 35% were associated with higher rates of the primary endpoint of all-cause mortality (53% versus 8%, log-rank p = 0.0001; HR 8.524; 95% CI 2.030–35.793, p = 0.003), as well as the secondary endpoints of MACE (53% versus 20%; log rank p = 0.011; HR 3.213, 95% CI 1.241–8.316, p = 0.016) and ES-R (35% versus 8%; log rank p = 0.019; HR 4.821, 95% CI 1.122–20.706, p = 0.034). Furthermore, ES patients with LVEF ≤ 35% showed higher rates of rehospitalization due to acute heart failure (24% versus 8%, statistical trend p = 0.096). Notably, ES patients with LVEF > 35% were associated with increased rates of rehospitalization due to ventricular tachycardia (36% versus 18%, statistical trend p = 0.083).
ES patients with LVEF ≤ 35% were associated with increased rates of all-cause mortality, MACE, ES-R and heart failure-related rehospitalization at long-term follow-up.
This study evaluated retrospectively the prognostic impact of LVEF in patients with ES. LVEF ≤ 35% was associated with increased long-term all-cause mortality (53% versus 8%; HR 8.524; 95% CI 2.030–35.793, p = 0.003), MACE (53% versus 20%; HR 3.213, 95% CI 1.241–8.316, p = 0.016), and ES recurrences (35% versus 8%; HR 4.821, 95% CI 1.122–20.706, p = 0.034), while trends were observed for higher rates of heart-failure related rehospitalization (24% versus 8%, p = 0.096) and MACE (49% versus 28%; p = 0.081).
KeywordsAcute heart failure Left ventricular ejection fraction Electrical storm Heart failure Sudden cardiac death MACE Mortality Hospitalization
The study was supported by the DZHK (Deutsches Zentrum fuer Herz-Kreislauf-Forschung - German Centre for Cardiovascular Research).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study is based on a retrospective data analysis/ registry and has been approved by the local ethics commission II of the Faculty of Medicine Mannheim, University of Heidelberg, where no informed consent was deemed necessary for this study (ethical approval number 2016-612NMA) (clinicaltrials.gov identifier: NCT02982473).
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