Shuang Zhao1, Keping Chen1, Yangang Su2, Wei Hua1, Jiefu Yang3, Silin Chen4, Zhaoguang Liang5, Wei Xu6, Shu Zhang1. 1. Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 2. Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China. 3. Department of Cardiology, Beijing Hospital, Beijing, China. 4. Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. 5. Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China. 6. Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing, PR China.
Abstract
BACKGROUND: Left ventricular ejection fraction (LVEF) ≤35% is the cutoff value used to identify patients at high risk of sudden cardiac death. However, whether patients who have moderate left ventricular dysfunction and left ventricular enlargement (LVE) have a high risk of ventricular arrhythmias (VAs) and cardiac death is unclear. HYPOTHESIS: Patients with moderate left ventricular dysfunction and LVE may have a high risk of VAs. METHODS: This study retrospectively analyzed the data of 853 patients who have an implantable cardioverter-defibrillator/cardiac resynchronization therapy cardioverter-defibrillator equipped with home monitoring. The patients were divided into 4 groups: group A, 35% < LVEF ≤ 45% and left ventricular end-diastolic dimension (LVEDD) ≥60 mm; group B, LVEF ≤35% and LVEDD <60 mm; group C, 35% < LVEF ≤ 45% and LVEDD <60 mm; and group D, LVEF ≤35% and LVEDD ≥60 mm. RESULTS: During a mean follow-up period of 30 ± 13 months, 324 patients (38%) experienced VAs and 125 patients (14.7%) experienced cardiac death. Based on multivariate Cox regression modeling, group A had an increased risk of VAs (A vs B, hazard ratio [HR]: 1.563, 95% confidence interval [CI]: 1.029-2.375, P = 0.036; A vs C, HR: 1.661, 95% CI: 1.204-2.294, P = 0.002) and cardiac death (A vs B, HR: 1.845, 95% CI: 1.013-3.356; A vs C, HR: 2.041, 95% CI: 1.136-3.731, P = 0.021). CONCLUSIONS: Patients with moderate left ventricular dysfunction and LVE have a high risk of VAs and cardiac death.
BACKGROUND: Left ventricular ejection fraction (LVEF) ≤35% is the cutoff value used to identify patients at high risk of sudden cardiac death. However, whether patients who have moderate left ventricular dysfunction and left ventricular enlargement (LVE) have a high risk of ventricular arrhythmias (VAs) and cardiac death is unclear. HYPOTHESIS: Patients with moderate left ventricular dysfunction and LVE may have a high risk of VAs. METHODS: This study retrospectively analyzed the data of 853 patients who have an implantable cardioverter-defibrillator/cardiac resynchronization therapy cardioverter-defibrillator equipped with home monitoring. The patients were divided into 4 groups: group A, 35% < LVEF ≤ 45% and left ventricular end-diastolic dimension (LVEDD) ≥60 mm; group B, LVEF ≤35% and LVEDD <60 mm; group C, 35% < LVEF ≤ 45% and LVEDD <60 mm; and group D, LVEF ≤35% and LVEDD ≥60 mm. RESULTS: During a mean follow-up period of 30 ± 13 months, 324 patients (38%) experienced VAs and 125 patients (14.7%) experienced cardiac death. Based on multivariate Cox regression modeling, group A had an increased risk of VAs (A vs B, hazard ratio [HR]: 1.563, 95% confidence interval [CI]: 1.029-2.375, P = 0.036; A vs C, HR: 1.661, 95% CI: 1.204-2.294, P = 0.002) and cardiac death (A vs B, HR: 1.845, 95% CI: 1.013-3.356; A vs C, HR: 2.041, 95% CI: 1.136-3.731, P = 0.021). CONCLUSIONS:Patients with moderate left ventricular dysfunction and LVE have a high risk of VAs and cardiac death.
Authors: Andrew E Epstein; John P DiMarco; Kenneth A Ellenbogen; N A Mark Estes; Roger A Freedman; Leonard S Gettes; A Marc Gillinov; Gabriel Gregoratos; Stephen C Hammill; David L Hayes; Mark A Hlatky; L Kristin Newby; Richard L Page; Mark H Schoenfeld; Michael J Silka; Lynne Warner Stevenson; Michael O Sweeney; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Jeffrey L Anderson; Christopher E Buller; Mark A Creager; Steven M Ettinger; David P Faxon; Jonathan L Halperin; Loren F Hiratzka; Sharon A Hunt; Harlan M Krumholz; Frederick G Kushner; Bruce W Lytle; Rick A Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Lynn G Tarkington; Clyde W Yancy Journal: Circulation Date: 2008-05-15 Impact factor: 29.690
Authors: Dennis M McNamara; Randall C Starling; Leslie T Cooper; John P Boehmer; Paul J Mather; Karen M Janosko; John Gorcsan; Kevin E Kip; G William Dec Journal: J Am Coll Cardiol Date: 2011-09-06 Impact factor: 24.094
Authors: Andrew E Epstein; John P DiMarco; Kenneth A Ellenbogen; N A Mark Estes; Roger A Freedman; Leonard S Gettes; A Marc Gillinov; Gabriel Gregoratos; Stephen C Hammill; David L Hayes; Mark A Hlatky; L Kristin Newby; Richard L Page; Mark H Schoenfeld; Michael J Silka; Lynne Warner Stevenson; Michael O Sweeney; Cynthia M Tracy; Andrew E Epstein; Dawood Darbar; John P DiMarco; Sandra B Dunbar; N A Mark Estes; T Bruce Ferguson; Stephen C Hammill; Pamela E Karasik; Mark S Link; Joseph E Marine; Mark H Schoenfeld; Amit J Shanker; Michael J Silka; Lynne Warner Stevenson; William G Stevenson; Paul D Varosy Journal: J Am Coll Cardiol Date: 2012-12-19 Impact factor: 24.094
Authors: A M Ross; K S Coyne; E Moreyra; J S Reiner; S W Greenhouse; P L Walker; M L Simoons; Y C Draoui; R M Califf; E J Topol; F Van de Werf; C F Lundergan Journal: Circulation Date: 1998-04-28 Impact factor: 29.690
Authors: Douglas P Zipes; A John Camm; Martin Borggrefe; Alfred E Buxton; Bernard Chaitman; Martin Fromer; Gabriel Gregoratos; George Klein; Arthur J Moss; Robert J Myerburg; Silvia G Priori; Miguel A Quinones; Dan M Roden; Michael J Silka; Cynthia Tracy; Jean-Jacques Blanc; Andrzej Budaj; Veronica Dean; Jaap W Deckers; Catherine Despres; Kenneth Dickstein; John Lekakis; Keith McGregor; Marco Metra; Joao Morais; Ady Osterspey; Juan Luis Tamargo; José Luis Zamorano; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Elliott M Antman; Jeffrey L Anderson; Sharon A Hunt; Jonathan L Halperin; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel Journal: Eur Heart J Date: 2006-09 Impact factor: 29.983
Authors: Ana Teresa Timóteo; Ana Galrinho; Luísa Moura Branco; Mário Martins Oliveira; Manuel Nogueira da Silva; Joana Feliciano; Rui Soares; Pedro Silva Cunha; Ana Leal; Sofia Santos; Rui Cruz Ferreira Journal: Rev Port Cardiol Date: 2010-06 Impact factor: 1.374