ABSTRACT
INTRODUCTION: Additional risk assessment in patients with heart failure referred for implantable cardioverterdefibrillator (ICD) implantation as primary prevention is needed. A reduction in left ventricular ejection fraction (LVEF) seems to lack sufficient sensitivity and specificity to be used for identification of patients at the highest risk of sudden cardiac death. OBJECTIVES: The aim of this study was to identify short- and longterm predictors of appropriate implantable cardioverterdefibrillator therapy as well as predictors of longterm mortality in patients with an ICD or cardiac resynchronization therapy defibrillator (CRTD). PATIENTS AND METHODS: In this retrospective study, data from 457 patients who had an ICD or CRTD implanted between 2011 and 2017 were analyzed. RESULTS: During the median followup of 31 months (interquartile range, 17-52 months), 153 patients died (33.9%) and 140 had appropriate interventions (31%). In a multivariate Cox regression analysis, implantation for secondary prevention (hazard ratio [HR], 2.49; P <0.001), severe mitral valve disease (HR, 2.17; P <0.001), and previous myocardial infarction (HR, 1.68; P = 0.009) were predictors of appropriate intervention. Resynchronization therapy (HR, 0.59; P = 0.025) and severe mitral valve disease (HR, 2.42; P <0.001) were predictors of appropriate intervention in primary prevention. Body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter were significant predictors of death. CONCLUSIONS: Implantation of ICD or CRTD as secondary prevention was a potent predictor of appropriate intervention, while resynchronization therapy and severe mitral regurgitation predicted ICD therapy in primary prevention. In patients with ICD or CRT-D, independent predictors of mortality included: body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter.
Subject(s)
Arrhythmias, Cardiac/therapy , Cardiac Resynchronization Therapy , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable , Aged , Arrhythmias, Cardiac/mortality , Female , Humans , Male , Middle Aged , Primary Prevention , Retrospective Studies , Risk Assessment , Risk Factors , Secondary PreventionABSTRACT
An asymptomatic Caucasian male patient underwent coronary artery disease diagnostics. Standard exercise treadmill test was inconclusive, and Holter ECG study didn't show any significant abnormalities. Considering the high risk of ischemic heart disease nuclear exercise stress test was performed,which revealed ST-segment elevation in the recovery phase of the treadmill exercise test. Single photon emission computed tomography (SPECT/CT) showed myocardial perfusion abnormalities in the inferior and lateral walls of the left ventricle. Furthermore,speckle tracking imaging showed subtle left ventricle dysfunction. Finally critical stenosis in the second segment of right coronary artery was diagnosed in coronary angiography.