PMID- 9768715
OWN - NLM
STAT- MEDLINE
DCOM- 19981020
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 32
IP  - 4
DP  - 1998 Oct
TI  - Prevalence and significance of nonsustained ventricular tachycardia in patients 
      with premature ventricular contractions and heart failure treated with 
      vasodilator therapy. Department of Veterans Affairs CHF STAT Investigators.
PG  - 942-7
AB  - OBJECTIVES: This study sought to determine the prevalence and significance of 
      nonsustained ventricular tachycardia (NSVT) in patients with premature 
      ventricular contractions (PVCs) and heart failure treated with vasodilator 
      therapy. BACKGROUND: Heart failure patients with ventricular arrhythmia and NSVT 
      have a significantly increased risk of premature cardiac death. Recently there 
      has been the question of whether these arrhythmias are expressions of a severely 
      compromised ventricle or are they independent risk factors. We, therefore, 
      determined the prevalence and significance of NSVT in patients with PVCs and 
      heart failure and on vasodilator therapy. METHODS: Twenty-four hour ambulatory 
      recordings were done at randomization, at 2 weeks, at months 1, 3, 6, 9 and 12 
      and then every 6 months in 674 patients with heart failure and on vasodilator 
      therapy. The median period of follow-up was 45 months (range 0 to 54). RESULTS: 
      Nonsustained ventricular tachycardia was present in 80% of all patients. Patients 
      without (group 1) and with (group 2) NSVT were balanced for variables: age, 
      etiology of heart disease, New York Heart Association (NYHA) functional class, 
      use of amiodarone and diuretics and left ventricular diameter by echocardiogram. 
      However, group 1 patients had significantly less beta-adrenergic blocking agent 
      use and higher ejection fraction (EF) (p < 0.002 and p < 0.001, respectively). 
      Survival analysis for all deaths showed a greater risk of death among group 2 
      patients (p=0.01). Similarly, sudden death was increased in group 2 patients 
      (p=0.02, risk ratio 1.8). After adjusting for the above variables, only EF 
      (p=0.001) and NYHA class (p=0.01) were shown to be independent predictors of 
      survival. Nonsustained ventricular tachycardia showed a trend (p=0.07) as an 
      independent predictor for all-cause mortality but not for sudden death. Only EF 
      was an independent predictor for sudden death. CONCLUSIONS: Nonsustained 
      ventricular tachycardia is frequently seen in patients with heart failure and may 
      be associated with worsened survival by univariate analysis. However, after 
      adjusting other variables, especially for EF, NSVT was not an independent 
      predictor of all-cause mortality or sudden death. These results have serious 
      implications in that suppression of these arrhythmias may not improve survival.
FAU - Singh, S N
AU  - Singh SN
AD  - VA Medical Center, Washington, DC 20422, USA. snsingh@erols.com
FAU - Fisher, S G
AU  - Fisher SG
FAU - Carson, P E
AU  - Carson PE
FAU - Fletcher, R D
AU  - Fletcher RD
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Vasodilator Agents)
RN  - N3RQ532IUT (Amiodarone)
SB  - IM
MH  - Aged
MH  - Amiodarone/*therapeutic use
MH  - Death, Sudden, Cardiac/etiology
MH  - Electrocardiography, Ambulatory
MH  - Heart Failure/complications/*drug therapy/mortality
MH  - Humans
MH  - Middle Aged
MH  - Prospective Studies
MH  - Risk Factors
MH  - Survival Rate
MH  - Tachycardia, Ventricular/*complications/diagnosis
MH  - Vasodilator Agents/*therapeutic use
MH  - Ventricular Premature Complexes/*complications/diagnosis
EDAT- 1998/10/13 00:00
MHDA- 1998/10/13 00:01
CRDT- 1998/10/13 00:00
PHST- 1998/10/13 00:00 [pubmed]
PHST- 1998/10/13 00:01 [medline]
PHST- 1998/10/13 00:00 [entrez]
AID - S0735109798003386 [pii]
AID - 10.1016/s0735-1097(98)00338-6 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 1998 Oct;32(4):942-7. doi: 10.1016/s0735-1097(98)00338-6.