Arrhythmic event prediction in patients with heart failure and reduced ejection fraction

Santangelo, Gloria; Bursi, Francesca; Negroni, Maria Silvia; Gentile, Domitilla; Provenzale, Giovanni; Turriziani, Laura; Zambelli, Daniel; Fiorista, Lorenzo; Bacchioni, Giuseppe; Massironi, Laura; Tarricone, Diego; Carugo, Stefano

doi:10.2459/jcm.0000000000001058

Cited by 5 publications

(9 citation statements)

References 21 publications

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“…Our analysis also found that the fQRS patients were significantly 1.5 years older than non-fQRS patients and had a 12% increased incidence of diabetes. Multiple studies have shown that age is not a contributing factor to VA in ICD patients (Santangelo et al, 2021), (Bergau et al, 2017), and we and others have found that comorbidities are not often associated with VA or appropriate ICD therapy (Engstrom et al, 2020). While some studies have demonstrated a link between diabetes and VA (Grisanti, 2018), others have reported the opposite (Juhani Junttila et al, 2020), which may be related to HF…”

Section: Fqrs Is Associated With Ventricular Arrhythmias In Hf Patientsmentioning

confidence: 83%

Fragmented QRS is associated with ventricular arrhythmias in heart failure patients: A systematic review and meta‐analysis

Engstrom

Dobson

et al. 2021

Noninvasive Electrocardiol

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Introduction: Many primary prevention heart failure (HF) patients with an implantable cardiac defibrillator (ICD) rarely experience life-threatening ventricular arrhythmias (VA). New strategies are required to identify patients most at risk of VA and sudden cardiac death who would benefit from an ICD. One potential method is the detection of fragmented QRS (fQRS) on the electrocardiogram. The aim was to assess the predictive capacity of fQRS for VA and mortality in ischemic (ICM) and non-ischemic cardiomyopathy (NICM) primary prevention HF patients. Methods and Results:A systematic review and meta-analysis of studies examining fQRS in HF patients with or without an ICD who met primary prevention indications with reduced ejection fraction ≤40%. Outcome measures were VA (or appropriate ICD therapy) and all-cause mortality. Ten studies involving 3885 patients were included for analysis. Most patients were male with non-fQRS patients being significantly younger (−1.5[−2.66, −0.42], p = .03). Diabetes was more likely in fQRS patients (1.12[1.01, 1.25], p = .03) while non-fQRS patients were 28% more likely to have a history of atrial fibrillation (0.82[0.67,1.00], p = .05). Ventricular arrhythmias were significantly 1.5 times more likely in patients with fQRS (1.51[1.02, 2.25], p = .04). HF patients were 1.7 times more likely to die of any cause if fQRS was present (1.68[1.13, 2.52], p = .01). NICM patients with fQRS have a significant 2.6-fold increased incidence of death compared with ICM patients (2.55[1.63, 3.98], p < .0001). Conclusion:fQRS is associated with VA and all-cause mortality and may be a novel marker in the risk stratification of primary prevention HF patients indicated for ICD implantation.

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Section: Fqrs Is Associated With Ventricular Arrhythmias In Hf Patientsmentioning

confidence: 83%

Fragmented QRS is associated with ventricular arrhythmias in heart failure patients: A systematic review and meta‐analysis

Engstrom

Dobson

et al. 2021

Noninvasive Electrocardiol

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“…A simple clinical score, based on comorbidities and NYHA class, identifies patients with more benefits from ICD implantation. 58 In another cohort (n ¼ 497), at long-term follow-up (median time 70.4 months), 16.5% had received at least one appropriate shock (3.12%/year), whereas 15.1% had received at least one inappropriate shock.…”

Section: Medical Therapymentioning

confidence: 96%

“…In a single-centre, retrospective, cohort study including 193 patients (51 nonischemic and 142 ischemic) with chronic HF and LVEF < 35% who had received ICD for primary prevention of sudden cardiac death, 32 (16.2%) patients presented sustained ventricular arrhythmias during a median follow-up of 1440 days. A simple clinical score, based on comorbidities and NYHA class, identifies patients with more benefits from ICD implantation 58 . In another cohort ( n = 497), at long-term follow-up (median time 70.4 months), 16.5% had received at least one appropriate shock (3.12%/year), whereas 15.1% had received at least one inappropriate shock.…”

Section: Devices and Telemonitoringmentioning

confidence: 99%

“…Implantable automatic defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are well established therapies for HFrEF patients. [57][58][59][60] However, some efforts have been recently made to identify patients who may have more benefit from these devices. In a single-centre, retrospective, cohort study including 193 patients (51 nonischemic and 142 ischemic) with chronic HF and LVEF < 35% who had received ICD for primary prevention of sudden cardiac death, 32 (16.2%) patients presented sustained ventricular arrhythmias during a median follow-up of 1440 days.…”

Section: Medical Therapymentioning

confidence: 99%

“…Implantable automatic defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are well established therapies for HFrEF patients 57–60 . However, some efforts have been recently made to identify patients who may have more benefit from these devices.…”

Section: Devices and Telemonitoringmentioning

confidence: 99%

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Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Cimino

Pancaldi

Tomasoni

et al. 2022

Journal of Cardiovascular Medicine

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Prevalence of heart failure is increasing worldwide mainly due to the ageing of the population and the improvement in diagnosis and treatment. In recent years, huge progress has been made in the management of heart failure patients. A new definition of chronic heart failure based on left ventricular ejection fraction and its possible trajectories has been reported. New drug classes have been introduced for the treatment of chronic heart failure. In particular, the prognostic benefit of sodium glucose co-transporter 2 inhibitors was demonstrated across all the heart failure phenotypes. Therapies for patients with advanced heart failure (long-term mechanical circulatory supports and heart transplantation) are now indicated also in the case of mild-to-moderate symptoms but with high risk of progression. In patients with acute heart failure, monitoring of urinary sodium and the use of acetazolamide may lead to better decongestion. Importantly, pre- and postdischarge assessment should lead to optimal treatment. Devices and telemonitoring can also be of help. Cardiovascular and noncardiovascular comorbidities are major determinants of the clinical course and need proper management. This review will summarize these important advances.

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Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients

Liu

Zhuo

et al. 2022

Cardiovasc Diabetol

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Background The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy. Methods We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs. Results Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36–1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56–2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35–2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39–0.79). Conclusion Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited.

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Arrhythmic event prediction in patients with heart failure and reduced ejection fraction

Cited by 5 publications

References 21 publications

Fragmented QRS is associated with ventricular arrhythmias in heart failure patients: A systematic review and meta‐analysis

Fragmented QRS is associated with ventricular arrhythmias in heart failure patients: A systematic review and meta‐analysis

Updates in heart failure: sodium glucose co-transporter 2 inhibitors and beyond – major changes are coming

Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients

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