Prognostic Role of Ventricular Ectopic Beats in Systemic Sclerosis: A Prospective Cohort Study Shows ECG Indexes Predicting the Worse OutcomeReportar como inadecuado




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Background

Arrhythmias are frequent in Systemic Sclerosis SSc and portend a bad prognosis, accounting alone for 6% of total deaths. Many of these patients die suddenly, thus prevention and intensified risk-stratification represent unmet medical needs. The major goal of this study was the definition of ECG indexes of poor prognosis.

Methods

We performed a prospective cohort study to define the role of 24h-ECG-Holter as an additional risk-stratification technique in the identification of SSc-patients at high risk of life-threatening arrhythmias and sudden cardiac death SCD. One-hundred SSc-patients with symptoms and-or signs suggestive of cardiac involvement underwent 24h-ECG-Holter. The primary end-point was a composite of SCD or need for implantable cardioverter defibrillator ICD.

Results

Fifty-six patients 56% had 24h-ECG-Holter abnormalities and 2424% presented frequent ventricular ectopic beats VEBs. The number of VEBs correlated with high-sensitive cardiac troponin T hs-cTnT levels and inversely correlated with left-ventricular ejection fraction LV-EF on echocardiography. During a mean follow-up of 23.1±16.0 months, 5 patients died suddenly and two required ICD-implantation. The 7 patients who met the composite end-point had a higher number of VEBs, higher levels of hs-cTnT and NT-proBNP and lower LV-EF p = 0.001 for all correlations. All these 7 patients had frequent VEBs, while LV-EF was not reduced in all and its range was wide. At ROC curve, VEBs>1190-24h showed 100% of sensitivity and 83% of specificity to predict the primary end-point AUROC = 0.92,p<0.0001. Patients with VEBS>1190-24h had lower LV-EF and higher hs-cTnT levels and, at multivariate analysis, the presence of increased hs-cTnT and of right bundle branch block on ECG emerged as independent predictors of VEBs>1190-24h. None of demographic or disease-related characteristics emerged as predictors of poor outcome.

Conclusions

VEBS>1190-24h identify patients at high risk of life-threatening arrhythmic complications. Thus, 24h-ECG-Holter should be considered a useful additional risk-stratification test to select SSc-patients at high-risk of SCD, in whom an ICD-implantation could represent a potential life-saving intervention.



Autor: Giacomo De Luca , Silvia Laura Bosello , Francesca Augusta Gabrielli, Giorgia Berardi, Federico Parisi, Manuela Rucco, Giovanni C

Fuente: http://plos.srce.hr/



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