PMID- 17437967
OWN - NLM
STAT- MEDLINE
DCOM- 20070913
LR  - 20070629
IS  - 1099-5129 (Print)
IS  - 1099-5129 (Linking)
VI  - 9
IP  - 6
DP  - 2007 Jun
TI  - Prediction of sudden death in heart failure patients: a novel perspective from 
      the assessment of the peak ectopy rate.
PG  - 385-90
AB  - AIMS: In patients with heart failure (HF), the association between sudden death 
      and arrhythmic pattern at 24-h Holter monitoring [number of ventricular premature 
      contractions per hour (VPCs/h) and presence of non-sustained ventricular 
      tachycardia (NSVT)] has previously been investigated with conflicting results. 
      Since both VPCs/h and NSVT disregard the time course of arrhythmic events, we 
      developed a new index based on the short-term peak rate of ectopies and 
      investigated its prognostic power in HF patients. METHODS AND RESULTS: We studied 
      200 HF patients in sinus rhythm [age: [median (interquartile range)] 54 years 
      [47-58], left ventricular ejection fraction (LVEF): 23% [19-28], New York Heart 
      Association (NYHA) class II-III: 88%]. For each patient, the Holter recording was 
      automatically scanned shifting a 30 beat window one beat at a time, and the 
      maximum number of ectopic beats found in a window was named peak ectopy rate 
      (PEAK_ER). The association between PEAK_ER and sudden death was assessed by Cox 
      proportional hazards regression analysis. Survival analysis was also carried out 
      adjusting for NYHA class, aetiology, LVEF, left ventricular end diastolic 
      diameter, blood urea nitrogen, amiodarone, Digoxin, beta-blockers, NSVT, VPCs/h, 
      and the standard deviation of all normal-to-normal beats. During a 5-year 
      follow-up [31 (12-60) months], 23 patients died of sudden death. Out of the 
      arrhythmic markers, PEAK_ER but not VPCs/h and NSVT was significantly associated 
      with sudden death in univariable analysis (RR: 1.08, 95% CI: 1.02-1.14, P = 
      0.005) and after adjustment for covariates (RR: 1.09, 95% CI: 1.03-1.15, P = 
      0.004). CONCLUSIONS: The investigation of the time course of arrhythmic events 
      provides independent information in the identification of patients at increased 
      risk of sudden death and may therefore be considered in the development of 
      treatment strategies in HF patients.
FAU - Casaleggio, Aldo
AU  - Casaleggio A
AD  - Biophysics Institute, CNR, Genova, Italy.
FAU - Maestri, Roberto
AU  - Maestri R
FAU - La Rovere, Maria Teresa
AU  - La Rovere MT
FAU - Rossi, Paolo
AU  - Rossi P
FAU - Pinna, Gian Domenico
AU  - Pinna GD
LA  - eng
PT  - Journal Article
DEP - 20070416
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
SB  - IM
MH  - Area Under Curve
MH  - Cardiac Output, Low/*mortality/*physiopathology
MH  - Circadian Rhythm
MH  - *Death, Sudden, Cardiac
MH  - *Electrocardiography, Ambulatory
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Risk Assessment
MH  - Ventricular Premature Complexes/*mortality/*physiopathology
EDAT- 2007/04/18 09:00
MHDA- 2007/09/14 09:00
CRDT- 2007/04/18 09:00
PHST- 2007/04/18 09:00 [pubmed]
PHST- 2007/09/14 09:00 [medline]
PHST- 2007/04/18 09:00 [entrez]
AID - eum050 [pii]
AID - 10.1093/europace/eum050 [doi]
PST - ppublish
SO  - Europace. 2007 Jun;9(6):385-90. doi: 10.1093/europace/eum050. Epub 2007 Apr 16.