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Risk of arrhythmic death in ischemic heart disease: a prospective, controlled, observer‐blind risk stratification over 10 years
Author(s) -
Pezawas Thomas,
Diedrich André,
Robertson David,
Winker Robert,
Richter Bernhard,
Wang Li,
Schmidinger Herwig
Publication year - 2017
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12729
Subject(s) - risk stratification , medicine , cardiology , prospective cohort study , stratification (seeds) , disease , seed dormancy , botany , germination , dormancy , biology
Background Risk of arrhythmic death is considered highest in ischemic heart disease with severe left ventricular ejection fraction (LVEF) reduction. Non‐invasive testing should improve decision‐making of prophylactic defibrillator (ICD) implantation. Design We enrolled 120 patients with ischemic heart disease and LVEF < 50% and 30 control subjects without ischemic heart disease and normal LVEF. An initial assessment, a second assessment after 3 years and a final follow‐up comprised of pharmacological baroreflex testing (BRS), short‐term spectral [low‐frequency (LF) to high‐frequency (HF) ratio] and long‐term time‐domain analysis of heart rate variability (SDNN), exercise Microvolt T‐wave alternans (MTWA) and others. Results The median follow‐up was 7·5 years. Resuscitated cardiac arrest and arrhythmic death due to ventricular arrhythmias ≥ 240/min was observed in 18% and 15% of patients, respectively. Cardiac death was observed in 28% of patients. The incidence of arrhythmic death and resuscitated cardiac arrest was identical in patients with ischemic heart disease with LVEF < 30% and ≥ 30%. No significant difference between subgroups with LVEF of < 30%, 30–39% and ≥ 40% was found either. MTWA, BRS, SDNN and LF to HF ratio failed to identify patients at risk of arrhythmic death in a multiple regression model. Conclusions Ischemic heart disease patients with LVEF < 30% and ≥ 30% face the same risk of arrhythmic death. Stratification techniques fail to identify high‐risk patients. Therefore, the current practice to constrain prophylactic ICDs to patients with severely reduced LVEF seems to be insufficient.