PMID- 33565237
OWN - NLM
STAT- MEDLINE
DCOM- 20210924
LR  - 20220531
IS  - 1879-0844 (Electronic)
IS  - 1388-9842 (Linking)
VI  - 23
IP  - 8
DP  - 2021 Aug
TI  - Dynamic changes in cardiovascular and systemic parameters prior to sudden cardiac 
      death in heart failure with reduced ejection fraction: a PARADIGM-HF analysis.
PG  - 1346-1356
LID - 10.1002/ejhf.2120 [doi]
AB  - AIMS: Prognostic models of sudden cardiac death (SCD) typically incorporate data 
      at only a single time-point. We investigated independent predictors of SCD 
      addressing the impact of integrating time-varying covariates to improve 
      prediction assessment. METHODS AND RESULTS: We studied 8399 patients enrolled in 
      the PARADIGM-HF trial and identified independent predictors of SCD (n = 561, 36% 
      of total deaths) using time-updated multivariable-adjusted Cox models, 
      classification and regression tree (CART), and logistic regression analysis. 
      Compared with patients who were alive or died from non-sudden cardiovascular 
      deaths, patients who suffered a SCD displayed a distinct temporal profile of New 
      York Heart Association (NYHA) class, heart rate and levels of three biomarkers 
      (albumin, uric acid and total bilirubin), with significant differences observed 
      more than 1 year prior to the event (P(interaction)  < 0.001). In multivariable 
      models adjusted for baseline covariates, seven time-updated variables 
      independently contributed to SCD risk (incremental likelihood chi-square = 46.2). 
      CART analysis identified that baseline variables (implantable 
      cardioverter-defibrillator use and N-terminal prohormone of B-type natriuretic 
      peptide levels) and time-updated covariates (NYHA class, total bilirubin, and 
      total cholesterol) improved risk stratification. CART-defined subgroup of highest 
      risk had nearly an eightfold increment in SCD hazard (hazard ratio 7.7, 95% 
      confidence interval 3.6-16.5; P < 0.001). Finally, changes over time in heart 
      rate, NYHA class, blood urea nitrogen and albumin levels were associated with 
      differential risk of sudden vs. non-sudden cardiovascular deaths (P < 0.05). 
      CONCLUSIONS: Beyond single time-point assessments, distinct changes in multiple 
      cardiac-specific and systemic variables improved SCD risk prediction and were 
      helpful in differentiating mode of death in chronic heart failure.
CI  - (c) 2021 European Society of Cardiology.
FAU - Rohde, Luis E
AU  - Rohde LE
AD  - Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA, USA.
AD  - Hospital de Clinicas de Porto Alegre and UFRGS Medical School, Porto Alegre, 
      Brazil.
FAU - Vaduganathan, Muthiah
AU  - Vaduganathan M
AD  - Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA, USA.
FAU - Claggett, Brian L
AU  - Claggett BL
AD  - Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA, USA.
FAU - Polanczyk, Carisi A
AU  - Polanczyk CA
AD  - Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA, USA.
AD  - Hospital de Clinicas de Porto Alegre and UFRGS Medical School, Porto Alegre, 
      Brazil.
FAU - Dorbala, Pranav
AU  - Dorbala P
AD  - Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA, USA.
FAU - Packer, Milton
AU  - Packer M
AD  - Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, 
      TX, USA.
FAU - Desai, Akshay S
AU  - Desai AS
AD  - Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA, USA.
FAU - Zile, Michael
AU  - Zile M
AD  - Medical University of South Carolina and Ralph H. Johnson Veterans Administration 
      Medical Center, Charleston, SC, USA.
FAU - Rouleau, Jean
AU  - Rouleau J
AD  - Institut de Cardiologie de Montreal, Universite de Montreal, Montreal, Canada.
FAU - Swedberg, Karl
AU  - Swedberg K
AD  - Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden, 
      London, UK.
FAU - Lefkowitz, Martin
AU  - Lefkowitz M
AD  - Novartis, East Hanover, NJ, USA.
FAU - Shi, Victor
AU  - Shi V
AD  - Novartis, East Hanover, NJ, USA.
FAU - McMurray, John J V
AU  - McMurray JJV
AD  - BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
FAU - Solomon, Scott D
AU  - Solomon SD
AD  - Division of Cardiovascular, Brigham and Women's Hospital, Boston, MA, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20210309
PL  - England
TA  - Eur J Heart Fail
JT  - European journal of heart failure
JID - 100887595
SB  - IM
CIN - Eur J Heart Fail. 2021 Aug;23(8):1357-1360. PMID: 33768627
CIN - Eur J Heart Fail. 2021 Aug;23(8):1361-1363. PMID: 33932259
MH  - Death, Sudden, Cardiac/epidemiology/etiology
MH  - *Defibrillators, Implantable
MH  - *Heart Failure/epidemiology/therapy
MH  - Humans
MH  - Proportional Hazards Models
MH  - Risk Factors
OTO - NOTNLM
OT  - Clinical predictors
OT  - Heart failure
OT  - Sudden cardiac death
EDAT- 2021/02/11 06:00
MHDA- 2021/09/25 06:00
CRDT- 2021/02/10 06:03
PHST- 2021/01/02 00:00 [revised]
PHST- 2020/10/27 00:00 [received]
PHST- 2021/02/02 00:00 [accepted]
PHST- 2021/02/11 06:00 [pubmed]
PHST- 2021/09/25 06:00 [medline]
PHST- 2021/02/10 06:03 [entrez]
AID - 10.1002/ejhf.2120 [doi]
PST - ppublish
SO  - Eur J Heart Fail. 2021 Aug;23(8):1346-1356. doi: 10.1002/ejhf.2120. Epub 2021 Mar 
      9.