Document Detail


Predictors of death and occurrence of appropriate implantable defibrillator therapies in patients with ischemic cardiomyopathy.
MedLine Citation:
PMID:  21094356     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Most patients with chronic ischemia and an implantable cardiac defibrillator (ICD) for primary prevention do not experience therapies for ventricular arrhythmias on follow-up. The present study aimed to identify independent clinical, electrocardiographic, and echocardiographic predictors of death and occurrence of ICD therapy in patients with chronic ischemic cardiomyopathy and ICD for primary prevention. A total of 424 patients with chronic ischemic cardiomyopathy, ejection fraction ≤ 35%, and New York Heart Association (NYHA) class ≥ II were recruited. All patients underwent echocardiography before ICD insertion. Primary outcome was all-cause mortality; secondary outcome was occurrence of appropriate ICD therapy on follow-up. Primary and secondary outcomes occurred in 84 and 95 patients, respectively. Patients who died were more likely to have diabetes (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.00 to 2.79, p = 0.049), higher NYHA class (HR 1.96, 95% CI 1.15 to 3.33, p = 0.013), lower peri-infarct strain on echocardiogram (HR 1.25, 95% CI 1.07 to 1.46, p = 0.005), and lower glomerular filtration rate (HR 1.01, 95% CI 1.00 to 1.03, p = 0.022). Only peri-infarct strain (HR 1.22, 95% CI 1.09 to 1.36, p < 0.001) predicted the occurrence of ICD therapy on follow-up. In conclusion, in chronic ischemic patients with an ICD for primary prevention, the presence of diabetes, renal dysfunction, higher NYHA class, and impaired peri-infarct zone function were predictors of all-cause mortality. In contrast, only impaired peri-infarct zone function determined the occurrence of appropriate ICD therapy on follow-up.
Authors:
Arnold C T Ng; Matteo Bertini; C Jan Willem Borleffs; Victoria Delgado; Eric Boersma; Sebastiaan R D Piers; Joep Thijssen; Gaetano Nucifora; Miriam Shanks; See Hooi Ewe; Mauro Biffi; Nico R L van de Veire; Dominic Y Leung; Martin J Schalij; Jeroen J Bax
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-10-14
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1566-73     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Aged
Death, Sudden, Cardiac / epidemiology*
Defibrillators, Implantable*
Electric Countershock / methods*
Electrocardiography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Ischemia / complications,  mortality,  therapy*
Prospective Studies
Single-Blind Method
Survival Rate
Tachycardia, Ventricular / etiology,  mortality,  prevention & control*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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