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.
AIM: This study aimed to conduct a comparative analysis of clinical, electrocardiographic, and echocardiographic factors in patients with chronic heart failure (CHF) with different hemodynamic responses to cardiac resynchronization (CRT) to assess the possibility of their use in predicting the positive effect of CRT. MATERIALS AND METHODS: The study included 136 patients with New York Heart Association grade 34 CHF with a left ventricular ejection fraction of 35%, QRS duration of 150 ms, QRS duration of 130149 ms, and QRS morphology of left bundle branch block (LBBB). For CHF treatment and primary prevention of sudden cardiac death, a cardioverter-defibrillator with CRT (CRT-D) function was implanted. The enrolled patients were followed up prospectively for 1 year to record the endpoint, namely, hemodynamic response to CRT, assessed by a decrease in the end-systolic volume of the left ventricle by 15%. RESULTS: During the 1-year follow-up, the primary endpoint was registered in 62 (46%) patients. With a one-way logistic regression, four indicators with the highest predictive potential (p 0.05) and associated with the occurrence of the studied endpoint were identified. Based on the results of the multivariate regression analysis, a prognostic model was developed, which included three factors with the highest levels of statistical significance, namely, a history of indications of a previous correction of valvular insufficiency, QRS duration, and LBBB criteria according to Strauss. The diagnostic efficiency of the model was 73% (sensitivity, 80%; specificity, 68%). The electrocardiographic parameters of the Strauss LBBB criteria and QRS duration were independent predictors of the studied endpoint. CONCLUSIONS: The developed multivariate prognostic model may be useful in the selection of patients with CHF reduced ejection fraction for implantation of devices with CRT function; the lack of external validation limits its application in practice.
Aim To compare variables of transthoracic EchoCG for determining echocardiographic predictors and their prognostic role in the development of persistent paroxysmal ventricular tachyarrhythmias (VT) in patients with ischemic CHF who had been implanted with a cardioverter defibrillator (CD) for primary prevention of sudden cardiac death.Material and methods This single-site prospective study included 176 patients with CHF of ischemic origin aged 58.7±7.4 years with a left ventricular ejection fraction (LV EF) of 30 % [25; 34] % who had been implanted with CD. The follow-up duration was 24 months. The primary endpoint was a newly developed persistent paroxysm of VT (duration ≥30 sec) detected in the “monitored” VT area or a VT paroxysm that required electric treatment. The echocardiographic picture was evaluated by 28 variables. Statistical analysis was performed with the c2, Fisher’s, and Mann—Whitney tests, and the one-factor logistic regression (LR). Prognostic models were developed with a multifactorial LR. The model accuracy was evaluated by 4 metrics: area under the ROC (AUC), sensitivity, specificity, and diagnostic efficacy.Results The primary endpoint was observed in 60 (34 %) patients. Mean time to a persistent VT episode was 19.2±0.8 months (95 % confident interval (CI): 17.5–20.8). Superior-inferior dimensions of the right and left atria (RA and LA, respectively) and the left atrial volume (LAv) were independent predictors for VT. The odds of VT development in patients of the study cohort increased with RAl ≥4.5 cm (odds ratio (OR), 1.6; 95 % CI: 1.4–1.9; р=0.03), LAl ≥5.5 cm (OR, 2.5; 95 % CI: 1.01–6.1; р=0.04), LAv ≥95 ml (OR, 3.2; 95 % CI: 1.3–17.5; р=0.01). A comprehensive analysis of echocardiographic variables proved the prognostic potential of LAv that was linearly associated with the development of VT. The metrics of the best prognostic model were AUC 0.7±0.07 with 95 % CI: 0.54–0.83; specificity, 20.9 %; sensitivity, 95.7 %; and diagnostic efficacy, 47 %.Conclusion This study allowed evaluation of capabilities of transthoracic EchoCG for predicting the probability of VT in patients with CHF of ischemic origin and reduced LV EF. It was shown that linear and volumetric atrial dimensions could be used for stratification of risk of VT and for determining the tactics for primary prevention of sudden cardiac death in this patient category.
Aim. To carry out a comparative analysis of left ventricular (LV) strain parameters, determined by the two-dimensional strain imaging in patients with heart failure (HF) with LV ejection fraction (EF) ≤35%, depending on the origin of HF.Material and methods. The study included 133 patients with NYHA class 3-4 HF with LVEF ≤35%, taking optimal therapy. Based on the HF origin, 2 following groups of patients were formed: ischemic cardiomyopathy (ICM) (n=70), nonischemic cardiomyopathy (NICM) (n=63). All patients underwent speckle-tracking echocardiography.Results. All patients included in the study showed significant alterations in longitudinal strain parameters in most myocardial segments, most pronounced in the basal and middle parts of the LV. Comparative analysis of the peak systolic longitudinal strain showed the worst characteristics in patients with ICM were found in the apical segments (p=0,008), and in patients with NICM, in the basal segments of the LV (p=0,046). The studied groups had comparable LV global longitudinal and circumferential strain (p=0,26; p=0,67; respectively).Conclusion. Groups of patients with HF of ischemic and non-ischemic origin, despite comparable LVEF values, differ in the distribution of the decrease in local longitudinal strain of LV segments. The worst strain characteristics in patients with ICM and NICM are detected in LV apical and basal segments, respectively.
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