Fatal cardio-vascular events risk stratification in ischemic heart disease patients with implantable cardioverter-defibrillators: role of noninvasive electrophysiological predictors

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Abstract

Aim. To study possibilities of non-invasive electrophysiological methods (microvolt Т-wave alternance - mTWA) heart rate turbulence (HRT), deceleration capacity (DC) use in stratifying risk of arrhythmic events and mortality in patients with ischemic heart disease (IHD) and implantable cardioverter-defibrillator (ICD). Materials and methods. The study included 45 patients with verified IHD diagnosis and indications for ICD implantation. In all patients serum creatinine level, glomerular filtration rate (GFR), and serum lipid fractions were determined and 24-hour Holter electrocardiogram (ECG) monitoring was performed where HRT, mTWA, and DC as well as acceleration capacity (AC), and heart rate variability (HRV) were determined. Survived patients were followed-up for no less than 30 months (mean follow-up 48 [42; 51] months, maximum - 70 months). The study endpoints were death from any cause and “arrhythmic” endpoint (appropriate ICD discharge or sudden cardiac death - SCD). Results. Ten (22.2%) patients died from different causes during follow-up period. Arrhythmic endpoint (appropriate ICD therapy or SCD) was observed in 13 (28.9%) cases. Significant differences in DC, CRT, and serum creatinine level were observed in patients who survived and died. No patients with normal CRT or in low-risk group died during follow-up. There were significant differences in number of ventricular extrasystoles (VES) morphologies according to 24-hour Holter ECG monitoring and in serum cholesterol level in patients with or without arrhythmic events. Multifactor regression analysis showed serum creatinine level to be an independent risk factor of lethal outcome, and both polytope VES and serum cholesterol level were shown to be independent predictors of arrhythmic endpoint. Conclusion. Non-invasive electrophysiological markers have demonstrated high negative significance in lethal outcome prognosis in patients with IHD and ICD. Serum creatinine level was shown to be the only independent lethal outcome predictor. Polytope VES and serum cholesterol level were demonstrated to be independent predictors of arrhythmic endpoint.

About the authors

Natalia V. Melnik

I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation

Email: natali-m05@mail.ru
Teaching Assistant at Department of Faculty Therapy №1 2, 8, Trubetskaia st., Moscow, 119991, Russian Federation

Dmitrii A. Tsaregorodtsev

I.M.Sechenov First Moscow State Medical University

Cand. Sci. (Med.), Assistant Professor at Department of Internal Medicine №1 2, 8, Trubetskaia st., Moscow, 119991, Russian Federation

Ilya L. Ilych

V.M.Buyanov City Clinical Hospital of the Department of Health of Moscow

Head of Cardiac Surgery Department 26, Bakinskaya st., Moscow, 115516, Russian Federation

Igor A. Khamnagadaev

V.M.Buyanov City Clinical Hospital

Cand. Sci. (Med.), cardiovascular surgeon in Cardiac Surgery Department 26, Bakinskaya st., Moscow, 115516, Russian Federation

Vitalii A. Sulimov

V.M.Buyanov City Clinical Hospital

2, 8, Trubetskaia st., Moscow, 119991, Russian Federation

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