Илов Н. Н.*-к.м.н., доцент кафедры сердечно-сосудистой хирургии, врачсердечно-сосудистый хирург отделения хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции, ORCID: 0000-0003-1294-9646, Пальникова О. В.-врач-кардиолог отделения хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции, ORCID: 0000-0002-4476-5174, Стомпель Д. Р.-зав. отделением функциональной диагностики, ORCID: 0000-0002-2400-8045, Николаева Е. В.-зав. отделением лучевой диагностики, ORCID: 0000-0001-5701-2449, Нечепуренко А. А.-к.м.н., зав. отделением хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции, ORCID: 0000-0001-5722-9883.
Aim To evaluate the diagnostic significance of clinical and demographic parameters for predicting a 2-year probability of ventricular tachyarrhythmias (VT) in patients with chronic heart failure and reduced left ventricular ejection fraction (CHFrLVEF).Material and methods This single-center, prospective cohort study included 175 patients with CHFrLVEF who were implanted with a cardioverter defibrillator (CD). The endpoint was a CD-detected episode of VT. Patients were followed up for 2 years with visits at 3, 12, and 24 months after CD implantation.Results The primary endpoint was observed in 43 (24.4 %) patients at an average of 20.9 months (95 % confidence interval (CI), 20–21.9). The 2-year risk of fatal ventricular arrhythmias increased with detection of unstable VT (one-factor analysis, odds ratio (OR), 4.2; 95 % CI, 1.1–16.5; р=0.041; multifactor analysis, OR, 6.3; 95 % CI, 1.5–26.3; р=0.012) and with ischemic CHFrLVEF origin (one-factor analysis, OR, 2.2; 95 % CI, 1.1–4.5; p=0.021; multifactor analysis, OR, 2.5; 95 % CI, 1.2–5.1; р=0.018). In the presence of any type of atrial fibrillation (AF) in patients with non-ischemic CHFrLVEF, the probability of VT increased threefold (one-factor analysis, OR, 2.97; 95 % CI, 1.02–8.8; р=0.047; multifactor analysis, OR, 3.5; 95 % CI, 1.1–10.9; р=0.032).Conclusion The presence of ischemic heart disease and unstable VT paroxysms can be included in the number of important clinical predictors of VT in patients with CHFrLVEF. In patients with non-ischemic CHF, the presence of AF is associated with a high risk of VT.
Aim. To perform a comparative analysis of indicators of transthoracic echocardiography (TE), to establish echocardiographic predictors and their predictive role in the occurrence of stable ventricular tachyarrhythmia (VT) paroxysms in patients with nonischemic chronic heart failure (HF) and cardioverter-defibrillator (ICD) implanted for primary prevention of sudden cardiac death.Material and Methods. A prospective study was carried out, which included 166 patients with nonischemic HF at the age of 54 (49; 59) years with the left ventricle ejection fraction (LV EF) ≤35% and an ICD implanted. The observation time was 24 months. The primary endpoint was the first-ever stable paroxysm of VT (lasting for ≥30 seconds), detected in the «monitor» zone of VT, or paroxysm of VT, which required ICD therapy. A total of 34 TE indicators were evaluated. Chi-square, Fischer, Manna-Whitney, single-factor logistic regression (LR), and multi-factor LR were used for data processing and analysis and for predictive modelling. Model accuracy was estimated using 4 metrics: ROC curve area (AUC), sensitivity, specificity and diagnostic efficiency.Results. During the two-year observation, 32 patients (19.3%) had a primary endpoint. The average time of occurrence of a stable VT episode was 21.6±0.6 months (95% confidence interval [CI] 20.5-22.8 months). The value of LV end-systolic dimension was the only parameter independently associated with VT (odds ratio 2.8 per unit increase, 95% CI 1.04-7.5; p=0.042). The complex analysis of echocardiographic indicators made it possible to identify 5 factors with the greatest predictive potential, which are linearly and nonlinearly related to occurrence of VT. These included the LV end-diastolic and end-systolic volumes, LV mass, index of relative LV wall thickness, upper-lower size of the right atrium. The metrics of the best predictive model were: AUC – 0.71 0.069 with 95% CI 0.574-0.843; specificity 50%, sensitivity 90.9%; diagnostic efficiency 57.1%.Conclusion. The study made it possible to evaluate the possibilities of the results of TE in predicting the probability of VT occurrence in patients with nonischemic HF and reduced LV EF. Predictive indicators have been identified that can be used to stratify the arrhythmic risk in the exposed cohort of patients.
Aim. To study the mortality rate of acute decompensated heart failure (ADHF) in patients with heart failure with reduced ejection fraction (HFrEF) within a year after implantation of cardioverter-defibrillator (ICD), to evaluate the potential of its prediction using transthoracic echocardiography.Material and methods. The study included 384 patients with NYHA class 3-4 heart failure with left ventricular ejection fraction (LVEF) ≤35%, who were scheduled for ICD implantation for the primary prevention of sudden cardiac death (SCD). After ICD implantation, enrolled patients were followed up for a year to record the primary endpoint of death due to ADHF.Results. During the 1-year follow-up, the primary endpoint was recorded in 38 patients (10%). A univariate logistic regression identified 14 echocardiographic parameters with the highest predictive potential (p<0,1) associated with the studied endpoint. Based on multivariate regression analysis, a prognostic model was developed, which included three factors with the highest statistical significance: LVEF, right atrial (RA) medial-lateral size, and pulmonary artery systolic pressure. The diagnostic efficiency of the model was 78,7% (sensitivity, 82,4%; specificity, 78,3%). A decrease in LVEF ≤28% and an increase in (RA) medial-lateral size ≥3,9 cm were found to be independent predictors of the studied endpoint.Conclusion. Approximately 10% of HFrEF patients selected for ICD implantation for primary prevention of SCD die due to ADHF during the 1-year follow-up. Transthoracic echocardiography has potential to predict this outcome.
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