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Prognostic impact of left ventricular ejection fraction in patients with electrical storm

  • Julian Müller
  • Michael BehnesEmail author
  • Dominik Ellguth
  • Tobias Schupp
  • Gabriel Taton
  • Linda Reiser
  • Thomas Reichelt
  • Armin Bollow
  • Seung-Hyun Kim
  • Christian Barth
  • Ahmad Saleh
  • Jonas Rusnak
  • Kathrin Weidner
  • Christoph A. Nienaber
  • Kambis Mashayekhi
  • Muharrem Akin
  • Thomas Bertsch
  • Christel Weiß
  • Martin Borggrefe
  • Ibrahim Akin
Article

Abstract

Objectives

The study sought to assess retrospectively the prognostic impact of left ventricular ejection fraction (LVEF) in patients with electrical storm (ES).

Background

Data regarding the prognostic impact of impaired LVEF in ES patients is rare.

Methods

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.

Results

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).

Conclusions

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.

Condensed abstract

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).

Keywords

Acute heart failure Left ventricular ejection fraction Electrical storm Heart failure Sudden cardiac death MACE Mortality Hospitalization 

Notes

Funding

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.

Ethical approval

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).

Informed consent

Not applicable.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Julian Müller
    • 1
  • Michael Behnes
    • 1
    Email author
  • Dominik Ellguth
    • 1
  • Tobias Schupp
    • 1
  • Gabriel Taton
    • 1
  • Linda Reiser
    • 1
  • Thomas Reichelt
    • 1
  • Armin Bollow
    • 1
  • Seung-Hyun Kim
    • 1
  • Christian Barth
    • 1
  • Ahmad Saleh
    • 1
  • Jonas Rusnak
    • 1
  • Kathrin Weidner
    • 1
  • Christoph A. Nienaber
    • 2
  • Kambis Mashayekhi
    • 3
  • Muharrem Akin
    • 4
  • Thomas Bertsch
    • 5
  • Christel Weiß
    • 6
  • Martin Borggrefe
    • 1
  • Ibrahim Akin
    • 1
  1. 1.First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine MannheimUniversity of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/MannheimMannheimGermany
  2. 2.Royal Brompton and Harefield Hospitals, NHSLondonUK
  3. 3.Department of Cardiology and Angiology IIUniversity Heart Center Freiburg • Bad KrozingenBad KrozingenGermany
  4. 4.Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
  5. 5.Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital NurembergParacelsus Medical UniversityNurembergGermany
  6. 6.Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine MannheimHeidelberg UniversityMannheimGermany

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