PMID- 10618302
OWN - NLM
STAT- MEDLINE
DCOM- 20000224
LR  - 20190623
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 101
IP  - 1
DP  - 2000 Jan 4-11
TI  - Ambulatory ventricular arrhythmias in patients with heart failure do not 
      specifically predict an increased risk of sudden death. PROMISE (Prospective 
      Randomized Milrinone Survival Evaluation) Investigators.
PG  - 40-6
AB  - BACKGROUND: Ventricular arrhythmias are a frequent finding in congestive heart 
      failure (CHF) patients and a cause of concern for physicians caring for them. 
      Previous studies have reached conflicting conclusions regarding the importance of 
      ventricular arrhythmias as predictors of sudden death in patients with CHF. This 
      study examined the independent predictive value of ventricular arrhythmias for 
      sudden death and all-cause mortality in PROMISE (Prospective Randomized Milrinone 
      Survival Evaluation). METHODS AND RESULTS: Ventricular arrhythmias were analyzed 
      and quantified by use of prespecified criteria on baseline ambulatory ECGs from 
      1080 patients with New York Heart Association (NYHA) class III/IV symptoms and a 
      left ventricular ejection fraction </=35% enrolled in PROMISE. The relationship 
      of ventricular arrhythmias and other clinical parameters to overall mortality and 
      sudden death classified by an independent, blinded mortality committee was 
      determined. There were 290 deaths, of which 139 were classified as sudden. Of the 
      several measures of ventricular ectopy that were univariate predictors, the 
      frequency of nonsustained ventricular tachycardia (NSVT) was the most powerful 
      predictor and remained a significant independent predictor when included with 
      other clinical variables in multivariate models of both sudden death mortality 
      and non-sudden death mortality. However, multiple logistic analysis with models 
      including the clinical variables with and without the NSVT variable demonstrated 
      that the frequency of NSVT did not add significant information beyond the 
      clinical variables. CONCLUSIONS: This study demonstrates that ventricular 
      arrhythmias do not specifically predict sudden death in patients with 
      moderate-to-severe heart failure. Thus, the finding of asymptomatic NSVT on 
      ambulatory ECG does not identify specific candidates for antiarrhythmic or device 
      therapy.
FAU - Teerlink, J R
AU  - Teerlink JR
AD  - Cardiovascular Research Institute and Department of Medicine, University of 
      California, and the Section of Cardiology, Department of Veterans Affairs Medical 
      Center, San Francisco, CA 94121, USA.
FAU - Jalaluddin, M
AU  - Jalaluddin M
FAU - Anderson, S
AU  - Anderson S
FAU - Kukin, M L
AU  - Kukin ML
FAU - Eichhorn, E J
AU  - Eichhorn EJ
FAU - Francis, G
AU  - Francis G
FAU - Packer, M
AU  - Packer M
FAU - Massie, B M
AU  - Massie BM
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Cardiotonic Agents)
RN  - JU9YAX04C7 (Milrinone)
SB  - IM
MH  - Arrhythmias, Cardiac/*complications/physiopathology
MH  - Cardiotonic Agents/*therapeutic use
MH  - Cause of Death
MH  - Death, Sudden, Cardiac/*epidemiology
MH  - Electrocardiography, Ambulatory
MH  - Female
MH  - Heart Failure/*complications/*drug therapy/mortality
MH  - Heart Ventricles
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Milrinone/*therapeutic use
MH  - Multivariate Analysis
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Regression Analysis
MH  - Risk Factors
MH  - Systole
EDAT- 2000/01/05 09:00
MHDA- 2000/02/26 09:00
CRDT- 2000/01/05 09:00
PHST- 2000/01/05 09:00 [pubmed]
PHST- 2000/02/26 09:00 [medline]
PHST- 2000/01/05 09:00 [entrez]
AID - 10.1161/01.cir.101.1.40 [doi]
PST - ppublish
SO  - Circulation. 2000 Jan 4-11;101(1):40-6. doi: 10.1161/01.cir.101.1.40.