Circulation. 2003;108:2883-2891
Published online before print November 17, 2003, doi: 10.1161/01.CIR.0000100721.52503.85
Published online before print November 17, 2003, doi: 10.1161/01.CIR.0000100721.52503.85
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(Circulation. 2003;108:2883.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Noninvasive Arrhythmia Risk Stratification in Idiopathic Dilated Cardiomyopathy
Results of the Marburg Cardiomyopathy Study
From the Department of Cardiology, Hospital of the Philipps-University of Marburg, and Medical Center for Methodology and Health Research, Institute of Medical Biometry and Epidemiology, Philipps-University of Marburg (H.-H.M.), Germany.
Correspondence to Wolfram Grimm, MD, Department of Cardiology, Philipps-University Marburg, Baldingerstraße, 35033 Marburg, Germany. E-mail wolfram.grimm{at}med.uni-marburg.de
Received July 1, 2003; revision received September 3, 2003; accepted September 4, 2003.
Background— Arrhythmia risk stratification with regard to prophylactic implantable cardioverter-defibrillator therapy is a completely unsolved issue in idiopathic dilated cardiomyopathy (IDC).
Methods and Results— Arrhythmia risk stratification was performed prospectively in 343 patients with IDC, including analysis of left ventricular (LV) ejection fraction and size by echocardiography, signal-averaged ECG, arrhythmias on Holter ECG, QTc dispersion, heart rate variability, baroreflex sensitivity, and microvolt T-wave alternans. During 52±21 months of follow-up, major arrhythmic events, defined as sustained ventricular tachycardia, ventricular fibrillation, or sudden death, occurred in 46 patients (13%). On multivariate analysis, LV ejection fraction was the only significant arrhythmia risk predictor in patients with sinus rhythm, with a relative risk of 2.3 per 10% decrease of ejection fraction (95% CI, 1.5 to 3.3; P=0.0001). Nonsustained ventricular tachycardia on Holter was associated with a trend toward higher arrhythmia risk (RR, 1.7; 95% CI, 0.9 to 3.3; P=0.11), whereas ß-blocker therapy was associated with a trend toward lower arrhythmia risk (RR, 0.6; 95% CI, 0.3 to 1.2; P=0.13). In patients with atrial fibrillation, multivariate Cox analysis also identified LV ejection fraction and absence of ß-blocker therapy as the only significant arrhythmia risk predictors.
Conclusions— Reduced LV ejection fraction and lack of ß-blocker use are important arrhythmia risk predictors in IDC, whereas signal-averaged ECG, baroreflex sensitivity, heart rate variability, and T-wave alternans do not seem to be helpful for arrhythmia risk stratification. These findings have important implications for the design of future studies evaluating prophylactic implantable cardioverter-defibrillator therapy in IDC.
Key Words: arrhythmia • cardiomyopathy • defibrillation
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