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Vol 75, No 7 (2017)
Original articles
Published online: 2017-03-15
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Risk stratification personalised model for prediction of life-threatening ventricular tachyarrhythmias in patients with chronic heart failure

Alexander Vladimirovich Frolov, Tatjana Gennadjevna Vaikhanskaya, Olga Petrovna Melnikova, Anatoly Pavlovich Vorobiev, Ludmila Michajlovna Guel
DOI: 10.5603/KP.a2017.0060
·
Kardiol Pol 2017;75(7):682-688.

open access

Vol 75, No 7 (2017)
Original articles
Published online: 2017-03-15

Abstract

Background: The development of prognostic factors of life-threatening ventricular tachyarrhythmias (VTA) and sudden cardiac death (SCD) continues to maintain its priority and relevance in cardiology. The development of a method of personalised prognosis based on multifactorial analysis of the risk factors associated with life-threatening heart rhythm disturbances is considered a key research and clinical task.

Aim: To design a prognostic and mathematical model to define personalised risk for life-threatening VTA in patients with chronic heart failure (CHF).

Methods: The study included 240 patients with CHF (mean-age of 50.5 ± 12.1 years; left ventricular ejection fraction 32.8 ± 10.9%; follow-up period 36.8 ± 5.7 months). The participants received basic therapy for heart failure. The elec­trocardiogram (ECG) markers of myocardial electrical instability were assessed including microvolt T-wave alternans, heart rate turbulence, heart rate deceleration, and QT dispersion. Additionally, echocardiography and Holter monitoring (HM) were performed. The cardiovascular events were considered as primary endpoints, including SCD, paroxysmal ventricular tachycardia/ventricular fibrillation (VT/VF) based on HM-ECG data, and data obtained from implantable device interrogation (CRT-D, ICD) as well as appropriated shocks.

Results: During the follow-up period, 66 (27.5%) subjects with CHF showed adverse arrhythmic events, including nine SCD events and 57 VTAs. Data from a stepwise discriminant analysis of cumulative ECG-markers of myocardial electrical instability were used to make a mathematical model of preliminary VTA risk stratification. Uni- and multivariate Cox logistic regression analysis were performed to define an individualised risk stratification model of SCD/VTA. A binary logistic regression model demonstrated a high prognostic significance of discriminant function with a classification sensitivity of 80.8% and specificity of 99.1% (F = 31.2; c2 = 143.2; p < 0.0001).

Conclusions: The method of personalised risk stratification using Cox logistic regression allows correct classification of more than 93.9% of CHF cases. A robust body of evidence concerning logistic regression prognostic significance to define VTA risk allows inclusion of this method into the algorithm of subsequent control and selection of the optimal treatment modality to treat patients with CHF.

Abstract

Background: The development of prognostic factors of life-threatening ventricular tachyarrhythmias (VTA) and sudden cardiac death (SCD) continues to maintain its priority and relevance in cardiology. The development of a method of personalised prognosis based on multifactorial analysis of the risk factors associated with life-threatening heart rhythm disturbances is considered a key research and clinical task.

Aim: To design a prognostic and mathematical model to define personalised risk for life-threatening VTA in patients with chronic heart failure (CHF).

Methods: The study included 240 patients with CHF (mean-age of 50.5 ± 12.1 years; left ventricular ejection fraction 32.8 ± 10.9%; follow-up period 36.8 ± 5.7 months). The participants received basic therapy for heart failure. The elec­trocardiogram (ECG) markers of myocardial electrical instability were assessed including microvolt T-wave alternans, heart rate turbulence, heart rate deceleration, and QT dispersion. Additionally, echocardiography and Holter monitoring (HM) were performed. The cardiovascular events were considered as primary endpoints, including SCD, paroxysmal ventricular tachycardia/ventricular fibrillation (VT/VF) based on HM-ECG data, and data obtained from implantable device interrogation (CRT-D, ICD) as well as appropriated shocks.

Results: During the follow-up period, 66 (27.5%) subjects with CHF showed adverse arrhythmic events, including nine SCD events and 57 VTAs. Data from a stepwise discriminant analysis of cumulative ECG-markers of myocardial electrical instability were used to make a mathematical model of preliminary VTA risk stratification. Uni- and multivariate Cox logistic regression analysis were performed to define an individualised risk stratification model of SCD/VTA. A binary logistic regression model demonstrated a high prognostic significance of discriminant function with a classification sensitivity of 80.8% and specificity of 99.1% (F = 31.2; c2 = 143.2; p < 0.0001).

Conclusions: The method of personalised risk stratification using Cox logistic regression allows correct classification of more than 93.9% of CHF cases. A robust body of evidence concerning logistic regression prognostic significance to define VTA risk allows inclusion of this method into the algorithm of subsequent control and selection of the optimal treatment modality to treat patients with CHF.

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Keywords

myocardial electrical instability, electrocardiography, heart failure, sudden cardiac death, tachyarrhythmias, risk stratification

About this article
Title

Risk stratification personalised model for prediction of life-threatening ventricular tachyarrhythmias in patients with chronic heart failure

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 75, No 7 (2017)

Pages

682-688

Published online

2017-03-15

DOI

10.5603/KP.a2017.0060

Bibliographic record

Kardiol Pol 2017;75(7):682-688.

Keywords

myocardial electrical instability
electrocardiography
heart failure
sudden cardiac death
tachyarrhythmias
risk stratification

Authors

Alexander Vladimirovich Frolov
Tatjana Gennadjevna Vaikhanskaya
Olga Petrovna Melnikova
Anatoly Pavlovich Vorobiev
Ludmila Michajlovna Guel

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