Noninvasive risk factors for the prediction of inducibility on programmed ventricular stimulation in post‐myocardial infarction patients with an ejection fraction ≥40% at risk for sudden cardiac arrest: Insights from the PRESERVE‐EF study. Issue 2 (6th December 2021)

• Record Type: Journal Article
• Authors: Trachanas, Konstantinos; Sideris, Skevos; Arsenos, Petros; Tsiachris, Dimitrios; Antoniou, Christos‐Konstantinos; Dilaveris, Polychronis; Triantafyllou, Konstantinos; Xenogiannis, Iosif; Tsimos, Konstantinos; Efremidis, Michalis; Kanoupakis, Emmanuel; Flevari, Panagiota; Vassilikos, Vassilios; Sideris, Antonios; Korantzopoulos, Panagiotis; Tousoulis, Dimitrios; Tsioufis, Konstantinos; Gatzoulis, Konstantinos
• Is Part Of: Annals of noninvasive electrocardiology. Volume 27:Issue 2(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-12-06
• Subjects: cardiac arrest/sudden cardiac death -- Holter/event recorders -- signal‐averaged ECG -- ventricular tachycardia/fibrillation; Electrocardiography -- Periodicals; Arrhythmia -- Periodicals; 616.1207547
• DOI: 10.1111/anec.12908
• Languages: English
• ISSNs: 1082-720X

Abstract

Abstract: Background: In the PRESERVE‐EF study, a two‐step sudden cardiac death (SCD) risk stratification approach to detect post‐myocardial infarction (MI) patients with left ventricle ejection fraction (LVEF) ≥40% at risk for major arrhythmic events (MAEs) was used. Seven noninvasive risk factors (NIRFs) were extracted from a 24‐h ambulatory electrocardiography (AECG) and a 45‐min resting recording. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS) and inducible patients received an Implantable Cardioverter ‐ Defibrillator (ICD). Methods: In the present study, we evaluated the performance of the NIRFs, as they were described in the PRESERVE‐EF study protocol, in predicting a positive PVS. In the PRESERVE‐EF study, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analyzed. Results: Among the NIRFs examined, the presence of signal averaged ECG‐late potentials (SAECG‐LPs) ≥ 2/3 and non‐sustained ventricular tachycardia (NSVT) ≥1 eposode/24 h cutoff points were important predictors of a positive PVS study, demonstrating in the logistic regression analysis odds ratios 2.285 ( p = .027) and 2.867 ( p = .006), respectively. A simple risk score based on the above cutoff points in combination with LVEF < 50% presented high sensitivity but low specificity for a positive PVS. Conclusion: Cutoff points of NSVT ≥ 1 episode/24 h and SAECG‐LPs ≥ 2/3 in combination with a LVEF < 50% were important predictors of inducibility. However, the final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification.