Prognostic significance of 24‐hour ambulatory electrocardiographic monitoring in patients with dilative cardiomyopathy: A prospective study

Abstract

Summary:We studied 33 patients with dilative cardomyopathy to evaluate the predicting factors for sudden death occurring within one year. The information on each of the patients included history, physical examinations, two-dimensional echocardiogranis, 24-h ambulatory electrocardiograms. and cardiac catheterization or autopsy. Patients were followed up for one year. Univariate analysis showed niaximurn number of premature ventricular complexes per hour (PVCs/h)(p= .0012), maximum beats per episode of ventricular tachycardia (VTmax) (p = .0012), and left ventricular end-diastolic pressure (p = ,046) to be significant prognostic risk indicators of sudden death within one year. To select the best combination of factors that predict sudden death, multivariate stepwise logistic regression analysis was performed. By this method, only PVCsIh and VTnlax were selected as the best combination. Probability of sudden cardiac death within I year= 1/( 1 +exp[6.65 -1.78 (log PVCs/h)-0.71 (VTm:in))). The equation showed 85.7 % sensitivity and 69.2% specificity at a probability cutoff p i n t of p = . 124, with accuracy of 72.7%. The incidence of sudden death was 80% in patients showing both frequent ( > 100/h) PVCs and presence of VT (VTrliaxz3), and 6 % in patients with neither or both. We concluded that PVCsIh and VTniax arc independent and significant prognostic factors in patients with dilative cardiomyopathy.

Abnormal T2-STIR Magnetic Resonance in Hypertrophic Cardiomyopathy: A Marker of Advanced Disease and Electrical Myocardial Instability

“…The presence of HyT2 was also associated with decreased heart rate variability, which suggests a sympathovagal imbalance, with decreased vagal tone, net sympathetic predominance, and subsequent cardiac electrical instability. Low heart rate variability is generally associated with an increased risk of sudden death in ischemic and non-ischemic heart disease [30]–[31] and the risk of arrhythmic events in patients with HCM [32]. In addition, the occurrence of NSVT is a risk factor for sudden cardiac death.…”

Chronic Frequent Premature Ventricular Complexes Originating From Right and Non-Right Ventricular Outflow Tracts Change in Left Ventricular Function After Radiofrequency Catheter Ablation

“…[1][2][3] PVC is the most commonly encountered tachyarrhythmia in clinical practice. Although reports on the long-term outcomes of frequent PVCs have been inconsistent, [4][5][6][7] chronic frequent PVCs have recently been reported to be associated with ventricular dilatation and deterioration of ventricular systolic function, and have been suggested to be a potential cause of DCM with uncertain etiology. 8,9) In addition, repetitive monomorphic PVCs from the outflow tracts have been suggested to be in a continuum with the common pathophysiology of sustained repetitive monomorphic ventricular tachycardia and nonsustained ventricular tachycardia (NSVT).…”

American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death

“…The remaining 37.3%, without couplets or NSVT, had a lower mortality rate of 26.3%. The sensitivity of NSVT in relationship to SCD or total death varies among several studies, ranging from 31% to 71% (120,122,129,130,(133)(134)(135). The positive predictive value is low, ranging from 20% to 50%, although the negative predictive value has been cited as 72% to 93%.…”