Clinical Electrophysiology -> SCA Risk Assessment: -> Clinical Risk Assessment Techniques D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-042 - Arrhythmic Risk Stratification In Heart Failure Mid-range Ejection Fraction Patients With A Non-invasive Guiding To Programmed Ventricular Stimulation Two-step Approach (ID 678)

Abstract

Background: Although some post myocardial infarction (post-MI) and dilated cardiomyopathy (DCM) patients with mid-range ejection fraction heart failure (HFmrEF=40-49%) face an increased risk for arrhythmic Sudden Cardiac Death (SCD), current guidelines do not recommend an implantable cardioverter - defibrillator (ICD).
Objective: To assess the accuracy of a novel multifactorial two-step approach, with noninvasive risk factors (NIRFs) leading to programmed ventricular stimulation (PVS), for SCD risk stratification of hospitalized HFmrEF patients.
Methods: Forty-eight patients (male=83%, age=64±14years, LVEF=45±5%, ischemic coronary disease=69%) underwent a NIRF presence screening first step with ECG, SAECG, echocardiography and 24hour ambulatory ECG (Holter). Thirty-two patients with presence of one out of three NIRFs (SAECG≥2 positive criteria for late potentials, ventricular premature beats≥240/24hours, and ≥1 episode of non-sustained ventricular tachycardia on Holter) were further stratified with PVS. Patients were classified as either low (Group 1, n=16, NIRFs-), moderate (Group 2, n=18, NIRFs+ /PVS-) or high risk (Group 3, n=14, NIRFs+/PVS+). All Group 3 patients received an ICD.
Results: After 41±18 months, 9 out of 48 patients experienced the major arrhythmic event (MAE) endpoint (clinical ventricular tachycardia/fibrillation=3, appropriate ICD activation=6). The endpoint occurred more frequently in Group 3 (7/14, 50%) than in Groups 1&2 (2/34, 5.8%). A logistic regression model adjusted for PVS, age and LVEF revealed that PVS was an independent MAE predictor (O.R:21.152, 95% C.I.: 2.618-170.887, p=0.004). Kaplan Meier curves diverged significantly (plogrank<0.001) while PVS negative predictive value was 94%.
Conclusion: In hospitalized HFmrEF post-MI and DCM patients, a NIRFs leading to PVS two-step approach efficiently detected the subgroup at increased risk for MAEs.
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