Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function.
Background: Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias.Methods and Res...
| Published in: | Journal of the American Heart Association Vol. 4; no. 8; pp. 1 - 12 |
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| Main Authors: | , , , , , , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Aug2015
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109174879&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 109174879 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20479980 FSQ9 jtl: Journal of the American Heart Association issn: 20479980 maglogo: Y pubinfo: dt: Aug2015 vid: 4 iid: 8 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 109174879 109174879 NLM26231842 109174879 10.1161/JAHA.114.001566 NLM26231842 PMC4599449 109174879 ppf: 1 ppct: 11 formats: tig: atl: Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function. aug: au: Aleong, Ryan G. Mulvahill, Matthew J. Halder, Indrani Carlson, Nichole E. Singh, Madhurmeet Bloom, Heather L. Dudley, Samuel C. Ellinor, Patrick T. Shalaby, Alaa Weiss, Raul Gutmann, Rebecca Sauer, William H. Narayanan, Kumar Chugh, Sumeet S. Saba, Samir London, Barry affil: University of Colorado, Denver CO sug: subj: Arrhythmia Etiology Ventricular Dysfunction, Left Complications Ventricular Function, Left Hypertrophy, Left Ventricular Complications Heart Failure Therapy Pathological Conditions, Anatomical Chi Square Test Male Female Hypertrophy, Left Ventricular Physiopathology Systole Death, Sudden, Cardiac Etiology Prospective Studies Time Factors Ventricular Dysfunction, Left Mortality Arrhythmia Therapy Death, Sudden, Cardiac Prevention and Control Risk Assessment Human Multivariate Analysis Hypertrophy, Left Ventricular Therapy Hypertrophy, Left Ventricular Diagnosis Defibrillators, Implantable Ventricular Dysfunction, Left Therapy Heart Transplantation Heart Failure Physiopathology United States Middle Age Heart Failure Etiology Prognosis Kaplan-Meier Estimator Arrhythmia Mortality Heart Assist Devices Hypertrophy, Left Ventricular Mortality Cardioversion Equipment and Supplies Ventricular Dysfunction, Left Physiopathology Arrhythmia Physiopathology Risk Factors Aged Cox Proportional Hazards Model Arrhythmia Diagnosis Treatment Outcomes Ventricular Dysfunction, Left Diagnosis Validation Studies Comparative Studies Evaluation Research Multicenter Studies Funding Source Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias.Methods and Results: Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV end-diastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009).Conclusions: LV dilatation may complement ejection fraction to predict ventricular arrhythmias.Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02045043. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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