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Risk stratification for serious arrhythmic events using nonsustained ventricular tachycardia and heart rate turbulence detected by 24-hour holter electrocardiograms in patients with left ventricular dysfunction.
MedLine Citation:
PMID:  22816545     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background: Previous studies have described the clinical usefulness of the presence of nonsustained ventricular tachycardia (NSVT) and defined heart rate turbulence (HRT) in stratifying patients at risk. We prospectively assessed whether HRT can facilitate the predictive accuracy of NSVT for identifying patients at risk for serious arrhythmic events in patients with left ventricular (LV) dysfunction. Methods: We enrolled 299 consecutive patients with LV dysfunction (ejection fraction ≤ 40%) including ischemic (n = 184) and nonischemic causes (n = 115). The presence of NSVT was assessed on Holter electrocardiograms (ECGs). HRT was simultaneously measured from Holter ECGs, assessing two parameters: turbulence onset (TO) and turbulence slope (TS). HRT was considered positive when both TO and TS were abnormal. The end point was defined as of sudden cardiac death (SCD) and sustained ventricular tachyarrhythmias (VTs). Results: NSVT was documented in 93 patients (32.7%). For HRT assessment, 17 patients (5.6%) were not utilized. Of 282 patients, 68 (24.1%) were HRT positive. During follow-up of 960 ± 444 days, 14 patients (5.0%) reached the end point. NSVT, HRT, and diabetes were significantly associated with the end point. On multivariate analysis, NSVT had  the strongest value for the end point, with an HR of 4.4 (95%CI, 1.4-14.3; P = 0.0138). When NSVT combined with HRT, the predictive accuracy is more increased, with an HR of 8.2 (95%CI, 2.9-23.3; P < 0.0001). The predictive values of the combination were higher than single use of NSVT or HRT. Conclusions: HRT can facilitate the predictive accuracy of NSVT for identifying patients at risk for serious arrhythmic events in patients with LV dysfunction.
Authors:
Yosuke Miwa; Hideaki Yoshino; Kyoko Hoshida; Mutsumi Miyakoshi; Takehiro Tsukada; Satoru Yusu; Takanori Ikeda
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  17     ISSN:  1542-474X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-07-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  260-7     Citation Subset:  IM    
Copyright Information:
©2012, Wiley Periodicals, Inc.
Affiliation:
Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan; and Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
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