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Predictors of serious arrhythmic events in patients with nonischemic heart failure

  • Mauricio Pimentel
  • André Zimerman
  • Diego Chemello
  • Vanessa Giaretta
  • Michael Andrades
  • Daiane Silvello
  • Leandro Zimerman
  • Luis E. Rohde
Article

Abstract

Purpose

Risk stratification of serious arrhythmic events in patients with nonischemic heart failure (HF), beyond estimates of left ventricular ejection fraction (LVEF), remains an important clinical challenge. This study aims to determine the clinical value of different noninvasive and invasive tests as predictors of serious arrhythmic events in patients with nonischemic HF.

Methods

A prospective observational study was conducted including 106 nonischemic HF patients who underwent a comprehensive clinical and laboratory evaluation including two-dimensional echocardiography, 24-h Holter monitoring, cardiopulmonary exercise testing (CPX), and an invasive electrophysiological study. The study’s primary end-point was either syncope, appropriate therapy by implantable cardioverter-defibrillators, or sudden cardiac death.

Results

During a mean follow-up of 704 ± 320 days, the primary end-point occurred in 15 patients (14.2%). In multivariable analysis, LV end-diastolic diameter >73 mm (hazard ratio [HR] 3.7; p = 0.016), exercise periodic breathing (EPB) on CPX (HR 2.88; p = 0.045), and non-sustained ventricular tachycardia (NSVT) ≥10 beats (HR 8.2; p < 0.01) remained independently associated with serious arrhythmic events. The positive predictive value of the presence of two of these predictors ranged from 44 to 100%. The absence of all three factors (n = 65, 61% of the sample) identified a subset of patients with low risk of future arrhythmic events, with a negative predictive value of 96.9%.

Conclusions

In this cohort study of nonischemic HF patients, LV dimension, EPB, and NSVT ≥10 beats were independent predictors of serious arrhythmic events. The presence or absence of these characteristics identified sub-groups of high and low risk of serious arrhythmic events, respectively.

Keywords

Heart failure Risk stratification Arrhythmia Sudden cardiac death 

Notes

Compliance with ethical standards

Funding

This paper was supported in part by grants from FIPE-HCPA (Fundo de Incentivo a Pesquisa do Hospital de Clínicas de Porto Alegre) and CNPq (research scholarship to L.E.R).

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mauricio Pimentel
    • 1
    • 4
  • André Zimerman
    • 2
    • 4
  • Diego Chemello
    • 1
    • 4
  • Vanessa Giaretta
    • 2
    • 4
  • Michael Andrades
    • 3
    • 4
  • Daiane Silvello
    • 3
    • 4
  • Leandro Zimerman
    • 1
    • 4
  • Luis E. Rohde
    • 2
    • 4
    • 5
  1. 1.Cardiac Electrophysiology Group, Cardiology DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
  2. 2.Heart Failure and Transplant Group, Cardiology DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
  3. 3.Cardiovascular Research Laboratory, Cardiology DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil
  4. 4.Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical SchoolUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  5. 5.Cardiology DivisionHospital de Clínicas de Porto AlegrePorto AlegreBrazil

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