Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model
Ramírez, Julia (Queen Mary University of London, London, United Kingdom)
Orini, Michele (Barts Heart Centre, St Bartholomeus Hospital, London, United Kingdom)
Mincholé, Ana (University of Oxford, Oxford, United Kingdom)
Monasterio, Violeta (Universidad San Jorge, Villanueva de Gállego)
Cygankiewicz, Iwona (Medical University of Lodz, Lodz, Poland)
Bayés de Luna, Antonio 1936- (Antoni) (Institut d'Investigació Biomèdica Sant Pau)
Martínez, Juan Pablo (Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina)
Laguna, Pablo (Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina)
Pueyo, Esther (Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina)
Universitat Autònoma de Barcelona

Data:	2017
Resum:	Sudden cardiac death (SCD) and pump failure death (PFD) are common endpoints in chronic heart failure (CHF) patients, but prevention strategies are different. Currently used tools to specifically predict these endpoints are limited. We developed risk models to specifically assess SCD and PFD risk in CHF by combining ECG markers and clinical variables. The relation of clinical and ECG markers with SCD and PFD risk was assessed in 597 patients enrolled in the MUSIC (MUerte Súbita en Insuficiencia Cardiaca) study. ECG indices included: turbulence slope (TS), reflecting autonomic dysfunction; T-wave alternans (TWA), reflecting ventricular repolarization instability; and T-peak-to-end restitution (Δ α Tpe ) and T-wave morphology restitution (TMR), both reflecting changes in dispersion of repolarization due to heart rate changes. Standard clinical indices were also included. The indices with the greatest SCD prognostic impact were gender, New York Heart Association (NYHA) class, left ventricular ejection fraction, TWA, Δ α Tpe and TMR. For PFD, the indices were diabetes, NYHA class, Δ α Tpe and TS. Using a model with only clinical variables, the hazard ratios (HRs) for SCD and PFD for patients in the high-risk group (fifth quintile of risk score) with respect to patients in the low-risk group (first and second quintiles of risk score) were both greater than 4. HRs for SCD and PFD increased to 9 and 11 when using a model including only ECG markers, and to 14 and 13, when combining clinical and ECG markers. The inclusion of ECG markers capturing complementary pro-arrhythmic and pump failure mechanisms into risk models based only on standard clinical variables substantially improves prediction of SCD and PFD in CHF patients.
Ajuts:	Ministerio de Economía y Competitividad TIN2013-41998-R Ministerio de Economía y Competitividad DPI2016-75458-R European Commission. Horizon 2020 638284
Nota:	Altres ajuts: Gobierno de Aragon BSICoS group (T96) ; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina MULTITOOLS2HEART ; European Social Fund BSICoS group (T96)
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 12 (october 2017) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0186152
PMID: 29020031

15 p, 2.3 MB

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