Open AccessNoninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post‐myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRESERVE‐EF study
Author(s) -
Trachanas Konstantinos,
Sideris Skevos,
Arsenos Petros,
Tsiachris Dimitrios,
Antoniou ChristosKonstantinos,
Dilaveris Polychronis,
Triantafyllou Konstantinos,
Xenogiannis Iosif,
Tsimos Konstantinos,
Efremidis Michalis,
Kanoupakis Emmanuel,
Flevari Panagiota,
Vassilikos Vassilios,
Sideris Antonios,
Korantzopoulos Panagiotis,
Tousoulis Dimitrios,
Tsioufis Konstantinos,
Gatzoulis Konstantinos
Publication year - 2022
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12908
Subject(s) - medicine , ejection fraction , cardiology , signal averaged electrocardiogram , ventricular tachycardia , myocardial infarction , ventricle , sudden cardiac death , implantable cardioverter defibrillator , ambulatory , electrocardiography , heart failure
Background In the PRESERVE‐EF study, a two‐step sudden cardiac death (SCD) risk stratification approach to detect post‐myocardial infarction (MI) patients with left ventricle ejection fraction (LVEF) ≥40% at risk for major arrhythmic events (MAEs) was used. Seven noninvasive risk factors (NIRFs) were extracted from a 24‐h ambulatory electrocardiography (AECG) and a 45‐min resting recording. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS) and inducible patients received an Implantable Cardioverter ‐ Defibrillator (ICD). Methods In the present study, we evaluated the performance of the NIRFs, as they were described in the PRESERVE‐EF study protocol, in predicting a positive PVS. In the PRESERVE‐EF study, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analyzed. Results Among the NIRFs examined, the presence of signal averaged ECG‐late potentials (SAECG‐LPs) ≥ 2/3 and non‐sustained ventricular tachycardia (NSVT) ≥1 eposode/24 h cutoff points were important predictors of a positive PVS study, demonstrating in the logistic regression analysis odds ratios 2.285 ( p = .027) and 2.867 ( p = .006), respectively. A simple risk score based on the above cutoff points in combination with LVEF < 50% presented high sensitivity but low specificity for a positive PVS. Conclusion Cutoff points of NSVT ≥ 1 episode/24 h and SAECG‐LPs ≥ 2/3 in combination with a LVEF < 50% were important predictors of inducibility. However, the final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.