Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function

Ryan G Aleong; Matthew J Mulvahill; Indrani Halder; Nichole E Carlson; Madhurmeet Singh; Heather L Bloom; Samuel C Dudley; Patrick T Ellinor; Alaa Shalaby; Raul Weiss; Rebecca Gutmann; William H Sauer; Kumar Narayanan; Sumeet S Chugh; Samir Saba; Barry London

doi:10.1161/JAHA.114.001566

Back

Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function

Journal article

Open access

Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function

Ryan G Aleong, Matthew J Mulvahill, Indrani Halder, Nichole E Carlson, Madhurmeet Singh, Heather L Bloom, Samuel C Dudley, Patrick T Ellinor, Alaa Shalaby, Raul Weiss, …

Journal of the American Heart Association, Vol.4(8), pp.e001566-e001566

07/31/2015

DOI: 10.1161/JAHA.114.001566

PMCID: PMC4599449

PMID: 26231842

Files and links (1)

url

https://doi.org/10.1161/JAHA.114.001566View

Published (Version of record) Open Access

Abstract

Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV end-diastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009). LV dilatation may complement ejection fraction to predict ventricular arrhythmias. URL: https://www.clinicaltrials.gov. Unique identifier: NCT02045043.

Aged

Arrhythmias, Cardiac - diagnosis

Arrhythmias, Cardiac - etiology

Arrhythmias, Cardiac - mortality

Arrhythmias, Cardiac - physiopathology

Arrhythmias, Cardiac - therapy

Chi-Square Distribution

Death, Sudden, Cardiac - etiology

Death, Sudden, Cardiac - prevention & control

Defibrillators, Implantable

Dilatation, Pathologic

Disease-Free Survival

Electric Countershock - instrumentation

Female

Heart Failure - etiology

Heart Failure - physiopathology

Heart Failure - therapy

Heart Transplantation

Heart-Assist Devices

Humans

Hypertrophy, Left Ventricular - complications

Hypertrophy, Left Ventricular - diagnosis

Hypertrophy, Left Ventricular - mortality

Hypertrophy, Left Ventricular - physiopathology

Hypertrophy, Left Ventricular - therapy

Kaplan-Meier Estimate

Male

Middle Aged

Multivariate Analysis

Proportional Hazards Models

Prospective Studies

Risk Assessment

Risk Factors

Systole

Time Factors

Treatment Outcome

United States

Ventricular Dysfunction, Left - complications

Ventricular Dysfunction, Left - diagnosis

Ventricular Dysfunction, Left - mortality

Ventricular Dysfunction, Left - physiopathology

Ventricular Dysfunction, Left - therapy

Ventricular Function, Left

Details

Title: Subtitle: Left Ventricular Dilatation Increases the Risk of Ventricular Arrhythmias in Patients With Reduced Systolic Function
Creators: Ryan G Aleong - University of Colorado Denver
Matthew J Mulvahill - University of Colorado Denver
Indrani Halder - University of Pittsburgh
Nichole E Carlson - University of Colorado Denver
Madhurmeet Singh - University of Pittsburgh
Heather L Bloom - Atlanta VA Medical Center
Samuel C Dudley - Brown University
Patrick T Ellinor - Massachusetts General Hospital
Alaa Shalaby - VA Pittsburgh Healthcare System
Raul Weiss - The Ohio State University
Rebecca Gutmann - University of Iowa
William H Sauer - University of Colorado Denver
Kumar Narayanan - Cedars-Sinai Medical Center
Sumeet S Chugh - Cedars-Sinai Medical Center
Samir Saba - University of Pittsburgh
Barry London - University of Iowa
Resource Type: Journal article
Publication Details: Journal of the American Heart Association, Vol.4(8), pp.e001566-e001566
DOI: 10.1161/JAHA.114.001566
PMID: 26231842
PMCID: PMC4599449
NLM abbreviation: J Am Heart Assoc
ISSN: 2047-9980
eISSN: 2047-9980
Grant note: R01 HL103946 / NHLBI NIH HHS R01 HL77398 / NHLBI NIH HHS UL1 TR001082 / NCATS NIH HHS
Language: English
Date published: 07/31/2015
Academic Unit: Molecular Physiology and Biophysics; Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984297507802771

Metrics

13 Record Views

41 Times Cited - Web of Science

See more details