The value of clinical variables for risk stratification in patients with sustained ventricular tachycardia

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The Value of Clinical Variables for Risk Stratification in Patients with Sustained Ventricular Tachycardia. Gijnter Steurer for the ‘Optimal Study’ group. Cardiovascular Center, O.L.V. Hospital, Aalst, Belgium.

Wltivariate clnalisis of the Variables CIffectin Ventricular Fibrillation in Patients with cku ? e Hyocardial Infarction Vadim Uuznetsov, Oleg Loginov, Natalia Kuznetsova, Sergei Osokin, Sergei Shalaev, Tatyana Gizatullna. Inst. Clin. & Prevent. Cardiol.,

In patients (pts) with ventricular tachycardia (VT) or fibrillation (VF) assessment of the individual risk for cardiovascular death remains a clinical challenge. Therefore, we analyzed the predictive value for total mortality and projected arrhythmic mortality in 20 preselected baseline variables derived from the patient’s history, stimulation (PES) and cardiac programmed electrical catheterization in 176 patients with VT or Vl/VF. The median followup was 12 months. Univariate analysis showed a significant relation between outcomeand: presence ofcoronatyarterydisease,PESinduced VT, LVEF 40%, PES-induced multipleVT morphologies, age more than 60 years,functional class for dyspnea NYHA Ill, need of direct currentshock to terminate PES-induced VT, VT within

2 months after myocardial infarction, associated AV conduction disturbances, aborted sudden death, and syncopal VT as presenting arrhythmia. In multivariate analysis, LVEF <30%, PESinduced VT. syncopal VT, need of direct current shock to terminate PES-induced VT, and male gender were significantly related to outcome. lnducibility of VT was the most sensitive and decreased LVEF was the most specific predictor of outcome. In conclusion, 1) LVEF <30%, PES-induced VT, syncopal VT, need of direct current shock to terminate PES-induced VT, and male gender were identified as independent predictors of outcome. 2) Clinical variables easily available from the patient’s history were significantly related to outcome and may be used to identify patients with VT of VT/VF at risk for cardiovascular death.

Predictive Value of Late Potentials in Survivors of Outof-Hospital Arrhythmic Cardiac Arrest A. Nobile, G. Pettinati, P.L. Mottironi, E. Adornato, A. Spampinato, M. Pistolese, F. Bellocci. Gruppo Italian0 Emergenze Cardiologiche - Rome - Italy The presence of late potentials(LPs) on signal-averaged (SA)ECG correlates with an increased risk of arrhythmic events and inducibility during programmed ventricular sti mulation(PVS).However, it has been suggested that the ele ctrophysiologic substrate in pts who present with ventri cular fibrillation(VF) might be different from that in pts with sustained ventricular tachycardia(SVT). Therefo re the value of LPs in these subgroups of pts may be dif ferent.We have evaluated the results of SA-ECG and PVS in 30 pts with documented arrhythmic cardiac arrest(ACA). Fifteen pts had coronary artery disease(CA0) and 15 idio pathic dilated cardiomyopathy(IOCMP).PVS induced fast SVT in 12 pts with CAD(60%) and in 5 pts with IDCMP(33%) (~4 0.005) and polimorphic VT or VF in no pt with CAD(O%) and in 5 pts with IDCMP(33%) (p
of fast

To,l;:=;ss

the with

i;rfo;;ed

and

parameters, examination, 24-hour two-dimensional and at

the

first

day

in 10 pts (gr.2) with

R=sul

value of fibrillation mulflvar-late

prognostic ventricular

unlvarlate

of

( r.l), M9 not

obtalned

factors, (VF)

ECG monitoring, Doppler myocardial

echocardi infarction

survived complicated

in

VF and by

we

analysis clinical M-mode,

on

ography (MI)

61 pts

VF.

t+: qr.

1

at-.2

b(bU’/) 7<70%)

MI class(>II)

Previous

Killip

Sedentary work LV dyski nesi a LV false tendon p value:

Dl

12(19 17) 10(1614%‘)

D2

O”/tJ

6idS ‘1’44

* L 7

G(GO%) 28(45.9%) : E; .9&l 5(50X) 11 (lG%) .Olll :0072 9(90X) 21(34.4X) .OOiO .0049 pi - by univariate analysis; p2 - by multivariate analysis

Univariated analysis showed significant differencies on frequencies of previous MI, more sedentary work severe Killip class, left ventricular (LV) dyskinesia LV false tendon between groups. Multivariale model revealed the aigni;;;~;~rcovgriance of VF with LV dyskine-

si a. not connected

size

nor

depth

of

MI alone

LV d:: ziat.1 on,

intravenous

fibrinolytic

traditionally considered factors. Thus, LV false tendon and exhibit the most significant development in pts with MI. PY,

were

with VF. LV false demonstendon the most statistically significant infon developing ‘JF. There was no marked of VF with LV myocardial hypertrophy,

trated luence relation

theraas

’

mogenic

arrhyth--

kyfe;;skinesia on

VF

0 24

0 23

It

Russia.

Tjumen,

SVT or VF).

Automatic

OTC

Lenghtening

Lifethreatening Eduard

Horns,

Antonio

Bay&

Dynamic

Xavier

However

using a computer PMIP

prone

to

automatically

manual

algorithm develop

and

during

for baseline

without

heart

sex to previous

known

6201

to influence

fraction Group

characteristics

we

Halter

ECG

in order to identify (MVA).

We

42 f 4%)

were

with

sustained MVA

Ill: 10 healthy

and matched not

undergoing

for age

undertaking

Hotter

on

I: 14 PMIP

II: 20 PMIP without

group

patients

before

Group

to group I. Group

as a control All

from

arrhytmias

of patients.

ejection

disease

in

reported.

beat to beat from data recorded

follow-up.

groups.

arrhythmias

time-consuming,

designed

ventricular

in 3 groups

QT interval

to be a reliable

as we have previous

OTC measurement

interval

Olga Guri,

Spain.

ventricular

we have recently

QTc

Maid,

ECG seems

are

of

Patients.

Gustavo

measurements

age 56 f 16 and mean

subjects

(PMIPI

malignant

system

VT (Bpts) or VF (6pts) and matched

on Halter

of automatic

measured

a 24h ICA Holter (mean

of

the value

as a Marker

Pa”, Barcelona,

of life-threatening patients

ECG

Infarction

Guindo,

de Sam

measured

infarction

because

determined

Josep

Hospital

for risk assessment

postmvocardial

in Halter

in Postmyocardial

Viiiolas,

de Luna.

OTC interval

method

measured

Arrhythmias

drugs

ECG.

RESULTS: Groups

Pts with

Mean QTc (msec)

peaks

% of beats

of OTC > 500msec

I

In=141

442+15*

7 (50%).

3 8%’

II

(n=20)

409*19

2 110%) 0 (0%)

0%

Ill In = 10) ??=

402 f 20

with

ClTc > 500msec

0:10x

p
CONCLUSIONS: 1 .-PMIP

who developed

MVA

exhibited

of OTC above

500msec.

2:Automatic

OTC measurement

feasible,

thus may

arrhythmic should

events,

be a reliable although

a longer QTc and presented

from

Halter

method

further

studies

be made to assess our preliminary

ECG is now

to stratify

PMIP

in larger

results.

available

peaks and

at high risk of

series

of patients