Impact of potentially lethal ventricular arrhythmias on long-term outcome in patients with chronic heart failure

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Author:
LIU Ye-hong(Department of Cardiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
SHEN Wei-feng(Department of Cardiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
SU Jing-ying(Department of Cardiology , Center Hospital of Minhang District,Shanghai 201100, China)
WANG Lin-jie(Department of Cardiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
LI Jin-ping(Department of Cardiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
ZHOU Qing-fen(Department of Cardiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
GAN Qian(Department of Cardiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
CHAI Xi-chen(Department of Cardiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
DAI Li-ying(Department of Cardiology , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
ZHANG Feng-ru(Department of Geriatrics , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
Journal Title:
Chinese Medical Journal
Issue:
Volume 125, Issue 04, 2012
DOI:
10.3760/cma.j.issn.0366-6999.2012.04.001
Key Word:
chronic heart failure;arrhythmia;outcome;electrocardiography

Abstract: Background Potentially lethal ventricular arrhythmias (PLVAs) occur frequently in survivors after acute myocardial infarction and are increasingly recognized in other forms of structural heart diseases.This study investigated the prevalence and prognostic significance of PLVAs in patients with chronic heart failure (CHF).Methods Data concerning demographics,etiology of heart failure,NYHA functional class,biochemical variables,electrocardiographic and echocardiographic findings,and medical treatments were collected by reviewing hospital medical records from 1080 patients with NYHA Ⅱ-Ⅳ and a left ventricular (LV) ejection fraction ≤45%.PLVAs were defined as multi-focal ventricular ectopy (>30 beats/h on Holter monitoring),bursts of ventricular premature beats,and nonsustained ventricular tachycardia.All-cause mortality,sudden death,and rehospitalization due to worsening heart failure,or cardiac transplantation during 5-year follow-up after discharge were recorded.Results The occurrence rate of PLVAs in CHF was 30.2%,and increased with age; 23.4% in patients <45 years old,27.8% in those between 45-65 years old,and 33.5% in patients >65 years old (P=0.033).Patients with PLVAs had larger LV size and lower ejection fraction (both P <0.01) and higher all-cause mortality (P=0.014) during 5-year follow-up than those without PLVAs.Age (OR 1.041,95% Cl 1.004-1.079,P=0.03) and LV end-diastolic dimension (OR 1.068,95% Cl 1.013-1.126,P=0.015) independently predicted the occurrence of PLVAs.And PLVA was an independent factor for all-cause mortality (RR 1.702,95% Cl 1.017-2.848,P=0.031) and sudden death (RR 1.937,95% CI 1.068-3.516,P=0.030) in patients with CHF.Conclusion PLVAs are common and exert a negative impact on Iona-term clinical outcome in patients with CHF.

  • 1.Tomaselli GF,Zipes DP.What causes sudden death in heart failure? Circ Res 2004; 95:754-763.
  • 2.Bigger JT Jr,Fleiss JL,Kleiger R,Miller JP,Rolnitzky LM.The Multicenter Post-Infarction Research Group.The relationship between ventricular arrhythmias,left ventricular dysfunction and mortality.Circulation 1984; 69:205-258.
  • 3.Roger VL,Go AS,Lloyd-Jones DM,Adams R J,Berry JD,Brown TM,et al.Heart disease and stroke statistics-2011update.A report from the American Heart Association.Circulation 2011; 123:e 18-e209.
  • 4.Stramba-Badiale M,Lazzarotti M,Facchini M,Schwartz PJ.Malignant arrhythmias and acute myocardial ischemia:interaction between flecainide and the autonomic nervous system.Am Heart J 1994; 128:973-982.
  • 5.Lakdawala NK,Givertz MM.Dilated cardiomyopathy with conduction disease and arrhythmia.Circulation 2010; 122:527-534.
  • 6.Dai SM,Zhang S,Chen KP,Hua W,Wang FZ,Chen X.Prognostic factors affecting the all-cause death and sudden cardiac death rates of post myocardial infarction patients with low left ventricular ejection fraction.Chin Med J 2009; 122:802-806.
  • 7.Francis GS.Development of arrhythmias in the patient with congestive heart failure:pathophysiology,prevalence and prognosis.Am J Cardiol 1986; 57:3B-7B.
  • 8.Podrid PJ,Fogel RI,Fuchs TT.Ventricular arrhythmia in congestive heart failure.Am J Cardiol 1992; 69:82G.
  • 9.Arthur W,Kaye GC.Tachyarrhythmias and heart failure.J Clin Basic Cardiol 2001; 4:115-122.
  • 10.Koilpillai C,Qui(n)ones MA,Greenberg B,Limacher MC,Shindler D,Pratt CM,et al.Relation of ventricular size and function to heart failure status and ventricular dysrhythmia in patients with severe left ventricular dysfunction.Am J Cardiol 1996; 77:606-611.
  • 11.Pfeffer MA,Braunwald E,Moyé LA,Basta L,Brown EJ Jr,Cuddy TE,et al.Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction-results of the survival and ventricular enlargement trial.N Engl J Med 1992; 327:669-677.
  • 12.Makkar KM, Sanoski CA, Spinler SA.Role of angiotensin-converting enzyme inhibitors,angiotensin Ⅱ receptor blockers, and aldosterone antagonists in the prevention of atrial and ventricular arrhythmias.Pharmacotherapy 2009; 29:31-48.
  • 13.Kantharia BK.Cardiac arrhythmias in congestive heart failure.Expert Rev Cardiovasc Ther 2010; 8:137-140.
  • 14.Cleland JG,Chattopadhyay S,Khand A,Houghton T,Kaye GC.Prevalence and incidence of arrhythmias and sudden death in heart failure.Heart Fail Rev 2002; 7:229-242.
  • 15.Teerlink JR,Jallaluddin M,Anderson S,Kukin ML,Eichhorn E J,Francis G,et al.Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death.Circulation 2000; 101:40-46.
  • 16.Doval HC,Nul DR,Grancelli HO,Varini SD,Soifer S,Corrado G,et al.Nonsustained ventricular tachycardia in severe heart failure.Independent marker of increased mortality due to sudden death.GESICA-GEMA Investigators.Circulation 1996; 94:3198-3203.
  • 17.Singh SN,Fisher SG,Carson PE,Fletcher RD,the Department of Veterans Affairs CHF STAT Investigators.Prevalence and significance of nonsustained ventricular tachycardia in patients with premature ventricular contractions and heart failure with vasodilator therapy.J Am Coll Cardiol 1998; 32:942-947.
  • 18.MERIT-HF Study Group.Effects of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF).Lancet 1999; 353:2001-2007.
  • 19.Fletcher RD,Cintron GB,Johnson G,Orndorff J,Carson P,Cohn JN.Enalapril decreases prevalence of ventricular tachycardia in patients with chronic congestive heart failure.The V-HeFT Ⅱ VA Cooperative Studies Group.Circulation 1993; 87 (6 Suppl):VI49-VI55.
  • 20.Mathew J,Hunsberger S,Fleg J,Mc Sherry F,Williford W,Yusuf S.Incidence,predictive factors,and prognostic significance of supraventricular tachyarrhythmias in congestive heart failure.Chest 2000; 118:914-922.
  • 21.Zhang RY,Wang LL,Zhang L,Meng XN,Li SJ,Wang WR.Effects of angiotensin converting enzyme inhibitor,angiotensin Ⅱ type Ⅰ receptor blocker and their combination on postinfarcted ventricular remodeling in rats.Chin Med J 2006; 119:649-655.
  • 22.Konstam MA,Rousseau MF,Kronenberg MW,Udelson JE,Melin J,Stewart D,et al.Effects of angiotensin converting enzyme inhibitor enalapril on the long term progression of ventricular dysfunction in patients with heart failure.Circulation 1992; 80:431-438.
  • 23.CIBIS-Ⅱ Investigators and Committees.The Cardiac Insufficiency Bisoprolol Study Ⅱ (CIBIS-Ⅱ):a randomised trial.Lancet 1999; 353:9-13.
  • 24.Luo M,Bi Y,Xu YX.Effects of metoprolol on β1 adrenergic receptor polymorphism and receptor density in urban Chinese patients with heart failure.Chin Med J 2007; 120:1720-1723.
  • 25.Frishman WH.Carvedilol.N Engl J Med 1998; 339:1759-1765.
  • 26.Kennedy HL.Beta-blocker prevention of proarrhythmia and proischemia:clues from CAST,CAMIAT,and EMIAT.Am J Cardiol 1997; 80:1208-1211.
  • 27.St John Sutton MG,Plappert T,Abraham WT,Smith AL,DeLurgio DB, Leon AR, et al.Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure.Circulation 2003; 107:1985-1990.
  • 28.Hua W.Cardiac resynchronization therapy for chronic heart failure in China:guideline and practice.Chin Med J 2010;123:2293-2294.
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