Academic Journal
Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter–defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study
| العنوان: | Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter–defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study |
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| المؤلفون: | Tereshchenko, Larisa G, Waks, Jonathan W, Tompkins, Christine, Rogers, Albert J, Ehdaie, Ashkan, Henrikson, Charles A, Dalouk, Khidir, Raitt, Merritt, Kewalramani, Shivangi, Kattan, Michael W, Santangeli, Pasquale, Wilkoff, Bruce W, Kapadia, Samir R, Narayan, Sanjiv M, Chugh, Sumeet S |
| المساهمون: | American Heart Association, Clinical and Translational Science Collaborative of Cleveland, National Center for Advancing Translational Sciences, National Institutes of Health, NIH roadmap for Medical Research |
| المصدر: | Europace ; volume 26, issue 6 ; ISSN 1099-5129 1532-2092 |
| بيانات النشر: | Oxford University Press (OUP) |
| سنة النشر: | 2024 |
| الوصف: | Aims Ablation of monomorphic ventricular tachycardia (MMVT) has been shown to reduce shock frequency and improve survival. We aimed to compare cause-specific risk factors for MMVT and polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF) and to develop predictive models. Methods and results The multicentre retrospective cohort study included 2668 patients (age 63.1 ± 13.0 years; 23% female; 78% white; 43% non-ischaemic cardiomyopathy; left ventricular ejection fraction 28.2 ± 11.1%). Cox models were adjusted for demographic characteristics, heart failure severity and treatment, device programming, and electrocardiogram metrics. Global electrical heterogeneity was measured by spatial QRS-T angle (QRSTa), spatial ventricular gradient elevation (SVGel), azimuth, magnitude (SVGmag), and sum absolute QRST integral (SAIQRST). We compared the out-of-sample performance of the lasso and elastic net for Cox proportional hazards and the Fine–Gray competing risk model. During a median follow-up of 4 years, 359 patients experienced their first sustained MMVT with appropriate implantable cardioverter–defibrillator (ICD) therapy, and 129 patients had their first PVT/VF with appropriate ICD shock. The risk of MMVT was associated with wider QRSTa [hazard ratio (HR) 1.16; 95% confidence interval (CI) 1.01–1.34], larger SVGel (HR 1.17; 95% CI 1.05–1.30), and smaller SVGmag (HR 0.74; 95% CI 0.63–0.86) and SAIQRST (HR 0.84; 95% CI 0.71–0.99). The best-performing 3-year competing risk Fine–Gray model for MMVT [time-dependent area under the receiver operating characteristic curve (ROC(t)AUC) 0.728; 95% CI 0.668–0.788] identified high-risk (> 50%) patients with 75% sensitivity and 65% specificity, and PVT/VF prediction model had ROC(t)AUC 0.915 (95% CI 0.868–0.962), both satisfactory calibration. Conclusion We developed and validated models to predict the competing risks of MMVT or PVT/VF that could inform procedural planning and future randomized controlled trials of prophylactic ventricular ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1093/europace/euae127 |
| DOI: | 10.1093/europace/euae127/57402570/euae127.pdf |
| الاتاحة: | http://dx.doi.org/10.1093/europace/euae127 https://academic.oup.com/europace/advance-article-pdf/doi/10.1093/europace/euae127/57402570/euae127.pdf https://academic.oup.com/europace/article-pdf/26/6/euae127/58341027/euae127.pdf |
| Rights: | https://creativecommons.org/licenses/by-nc/4.0/ |
| رقم الانضمام: | edsbas.9EAE6B48 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1093/europace/euae127 |
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