Accumulation of risk markers predicts the incidence of sudden death in patients with chronic heart failure

Abstract

Background: Sudden death is common in chronic heart failure (CHF). Risk stratification is the first step for primary prevention. Aim: To evaluate the use of risk markers for estimating sudden death risk. Methods and results: We prospectively examined 680 stable patients with CHF. Risk markers were evaluated using the Cox's proportional hazard model in a stepwise manner. Ejection fraction < 30%, left ventricular end-diastolic diameter > 60 mm, brain natriuretic peptide > 200 pg/ml, non-sustained ventricular tachycardia, and diabetes were significantly associated with increased risk of sudden death. When the number of risk markers were included as co-variables, only ''number of risk markers 3µ entered the model (hazard ratio 8.95, 95% confidence interval 4.57 -17.52), while the effects of individual markers did not enter the model. The annual mortality from sudden death was 11% in patients with 3 or more risk markers and 1.4% in patients with 2 or less. Conclusions: Rather than particular risk markers, the number of accumulated risk markers was a more powerful predictor for sudden death in patients with CHF. The number of risk markers could be useful for risk stratification of sudden death.

Current Status of Primary Prevention of Sudden Cardiac Death With Implantable Cardioverter Defibrillator in Patients With Chronic Heart Failure

“…40 We also reported that LVDd >60 mm was one of the independent risk markers of SCD in CHF patients in the CHART-1 study. 41 In contrast, in the present CHART-2 study, LVDd >65 mm, but not LVDd >60 mm, was a significant risk factor on univariate and multivariate Cox hazard analysis. We consider that the difference between the CHART-1 and CHART-2 studies is due to the difference in the patients studied.…”

“…They showed that the annual mortality from sudden death was 11% in patients with ≥3 risk factors and 1.4% in patients with ≤2. 41 In the present study, the presence of cAF or LVDd ≥65 mm had higher relative HR and their combination achieved the highest HR.…”

“…LV enlargement has also been reported to be a predictor of SCD in CHF, IHD with HFrEF and NIDCM patients. 40, 41 It was reported that the combination of LVDd >70 mm and NSVT on Holter ECG was an independent arrhythmia risk predictor in German patients with idiopathic DCM. 40 We also reported that LVDd >60 mm was one of the independent risk markers of SCD in CHF patients in the CHART-1 study.…”

Arrhythmogenic Phenotype in Dilated Cardiomyopathy: Natural History and Predictors of Life‐Threatening Arrhythmias

“…Grimm et al found that NSVT with a duration of ≥5 beats was significantly associated with increased risk of major arrhythmic events including SCD 17. Furthermore, the heart rate in NSVT has been arbitrary,26, 27, 28 ranging from ≥100 to 150 bpm, and not associated with increased risk of life‐threatening arrhythmias and SCD in DCM 17, 18, 29. In our study, we arbitrarily defined NSVT as ≥5 consecutive ventricular premature beats with a rapid heart rate (≥150 bpm), corresponding to the median ventricular rate previously reported in our DCM population 29.…”

“…AR‐DCM phenotype was diagnosed by the presence of 1 of the following: (1) unexplained syncope (likely due to ventricular tachyarrhythmia),2, 14, 15, 16 (2) rapid nonsustained ventricular tachycardia (NSVT) defined as ≥5 consecutive ventricular beats,17 lasting <30 seconds, with a rate ≥150/min on 24‐hour Holter monitoring,18 (3) ≥1000 premature ventricular contractions (PVCs) in 24 hours1 or (4) ≥50 couplets in 24 hours 19. ICD implantation had been performed for primary prevention in selected patients with DCM considered at high risk for SCD (ie, persistent LV dysfunction with LVEF ≤35% and New York Heart Association class II or III while being treated with optimal medical therapy).…”