Arrhythmia Risk Stratification in Idiopathic Dilated Cardiomyopathy Based on Echocardiography and 12-Lead, Signal-Averaged, and 24-Hour Holter Electrocardiography

Wolfram Grimm, MD, Christina Glaveris, MD, Jürgen Hoffmann, MD, Volker Menz, MD, Hans-Helge Müller, PhD, Günther Hufnagel, MD, Bernhard Maisch, MD, 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, Marburg, Germany.

Am Heart J. 2000;140(1) 

In This Article

Results

During 32 ± 15 months of follow-up, arrhythmic events were observed in 32 (16%) of 202 study patients (Table II). Four patients (2%) survived an episode of sustained VT or VF. Sudden death occurred in 17 patients (8%), and another 3 patients (1%) died within 3 days from shock-induced multiorgan failure after initially successful prolonged resuscitation out of hospital with ECG-documented VF. Eight (22%) of 37 patients with prophylactic ICD therapy received appropriate ICD shocks for rapid VT or VF, as documented by stored ECGs (Figure 2). Follow-up duration between prophylactic ICD implant and occurrence of the first appropriate shock in these 8 patients was 13 ± 11 months (range 3 to 33 months). Mean rate of the most rapid episode of VT or VF triggering device therapy in each of the 8 patients was 255 ± 30 beats/min (range 210 to 300 beats/min). The results of univariate and multivariate Cox analysis of the association between the 11 predefined clinical variables and arrhythmic events as well as transplant-free survival are summarized in Tables II and IV and in Figure 3. In addition, the numerical values for each assessed parameter of the signal-averaged ECG are provided in Table V.

Stored electrogram of spontaneous ventricular flutter terminated by a 34 J shock in patient with IDC in whom prophylactic ICD implantation had been performed at the time of study entry.

Kaplan-Meier curves showing the proportion of patients without arrhythmic event stratified for LV end-diastolic diameter (LVEDD) >=70 mm vs <70 mm (A); LV ejection fraction (EF) >=30% vs >30% (B); presence or absence of nonsustained VT (NSVT) on baseline Holter (C); patients without NSVT and LVEDD <70 mm, patients with NSVT or LVEDD >=70 mm, and patients with NSVT and LVEDD >=70 mm (D); and patients without NSVT and EF >30%, patients with NSVT or EF >=30%, and patients with NSVT and EF >= 30% (E).

During 32 ± 15 months of follow-up, 38 patients died (19%) and 8 patients (4%) underwent successful heart transplantation. The cause of death was classified as sudden death in 17 patients (8%) and arrhythmic nonsudden death in 3 patients (2%). Death from progressive heart failure occurred in 16 patients (8%), and noncardiac deaths from sepsis and pancreatic carcinoma were observed in 2 patients (1%). After adjustment for potential confounding clinical covariates (Table III), multivariate Cox analysis demonstrated a significant inverse relation between transplant-free survival and LV ejection fraction >=30%, LV end-diastolic diameter >=70 mm, and nonsustained VT on Holter (Table II, Figure 4).

Kaplan-Meier curves for transplant-free survival stratified for LV ejection fraction (EF) >=30% vs >30% (A); LV end-diastolic diameter (LVEDD) >=70 mm vs <70 mm (B); presence or absence of nonsustained VT (NSVT) on baseline Holter (C); and patients without NSVT and EF >30% and LVEDD <70 mm, patients with NSVT or EF >=30% or LVEDD >=70 mm or 2 of these 3 variables, and patients with NSVT and EF >=30% and LVEDD >=70 mm (D).

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