Abstract 2109: Predicting Total Mortality and Sudden Death in Heart Failure Patients with Ejection Fraction >35%.
Background. Based on current indications, congestive heart failure (CHF) patients with EF≤35% could be qualified for prophylactic ICD therapy. Since the majority of sudden cases occur in patients with EF>35% we evaluated the prognostic significance of clinical and ECG-based parameters for predicting total mortality (TM), sudden death (SD) and non-sudden death (NSD) in CHF patients with LVEF>35%.
Methods. Among 723 CHF patients of various etiologies with NYHA II or III enrolled in the MUSIC study, there were 330 (46%) patients who had EF>35%. 24-hour Holter monitoring was performed at enrollment to assess slope of the QTa/RR and QTe/RR as well as heart rate turbulence (HRT) parameters. Patients were followed for median of 26 months with primary endpoint defined as TM and secondary as SD.
Results. Among 330 pts with EF>35% (269 pts in NYHA class II, 132 pts with previous myocardial infarction) there were 26 deaths including 11 SCD and 15 NSD. Atrial fibrillation was present in 69 (21%) patients. Among remaining 261 patients in sinus rhythm, HRT was calculable in 222 patients and QT/RR parameters were calculated in 198 patients. Results of the multivariate analyses predicting endpoints with p<0.10 as entry criterion are presented in Table⇓ below
Conclusions. Increased risk of mortality could be predicted in CHF patients with EF>35% by combination of clinical variables and dynamic ECG parameters. Abnormal heart rate turbulence and QT/RR dynamics are predictive for total mortality with QT/RR showing the strongest predictive value for sudden cardiac death as well as for non-sudden death