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Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model
BACKGROUND: 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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636125/ https://www.ncbi.nlm.nih.gov/pubmed/29020031 http://dx.doi.org/10.1371/journal.pone.0186152 |
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author | Ramírez, Julia Orini, Michele Mincholé, Ana Monasterio, Violeta Cygankiewicz, Iwona Bayés de Luna, Antonio Martínez, Juan Pablo Laguna, Pablo Pueyo, Esther |
author_facet | Ramírez, Julia Orini, Michele Mincholé, Ana Monasterio, Violeta Cygankiewicz, Iwona Bayés de Luna, Antonio Martínez, Juan Pablo Laguna, Pablo Pueyo, Esther |
author_sort | Ramírez, Julia |
collection | PubMed |
description | BACKGROUND: 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. METHODS: 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 (Δα(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. RESULTS: The indices with the greatest SCD prognostic impact were gender, New York Heart Association (NYHA) class, left ventricular ejection fraction, TWA, Δα(Tpe) and TMR. For PFD, the indices were diabetes, NYHA class, Δα(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. CONCLUSION: 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. |
format | Online Article Text |
id | pubmed-5636125 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-56361252017-10-30 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 Orini, Michele Mincholé, Ana Monasterio, Violeta Cygankiewicz, Iwona Bayés de Luna, Antonio Martínez, Juan Pablo Laguna, Pablo Pueyo, Esther PLoS One Research Article BACKGROUND: 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. METHODS: 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 (Δα(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. RESULTS: The indices with the greatest SCD prognostic impact were gender, New York Heart Association (NYHA) class, left ventricular ejection fraction, TWA, Δα(Tpe) and TMR. For PFD, the indices were diabetes, NYHA class, Δα(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. CONCLUSION: 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. Public Library of Science 2017-10-11 /pmc/articles/PMC5636125/ /pubmed/29020031 http://dx.doi.org/10.1371/journal.pone.0186152 Text en © 2017 Ramírez et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Ramírez, Julia Orini, Michele Mincholé, Ana Monasterio, Violeta Cygankiewicz, Iwona Bayés de Luna, Antonio Martínez, Juan Pablo Laguna, Pablo Pueyo, Esther Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model |
title | Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model |
title_full | Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model |
title_fullStr | Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model |
title_full_unstemmed | Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model |
title_short | Sudden cardiac death and pump failure death prediction in chronic heart failure by combining ECG and clinical markers in an integrated risk model |
title_sort | sudden cardiac death and pump failure death prediction in chronic heart failure by combining ecg and clinical markers in an integrated risk model |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636125/ https://www.ncbi.nlm.nih.gov/pubmed/29020031 http://dx.doi.org/10.1371/journal.pone.0186152 |
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