TY - JOUR
T1 - Predicting sustained ventricular arrhythmias in dilated cardiomyopathy
T2 - a meta-analysis and systematic review
AU - Sammani, Arjan
AU - Kayvanpour, Elham
AU - Bosman, Laurens P
AU - Sedaghat-Hamedani, Farbod
AU - Proctor, Tanja
AU - Gi, Weng-Tein
AU - Broezel, Alicia
AU - Jensen, Katrin
AU - Katus, Hugo A
AU - Te Riele, Anneline S J M
AU - Meder, Benjamin
AU - Asselbergs, Folkert W
N1 - Funding Information:
This project received funding from the European Union's Horizon 2020 research and innovation programme under the ERA‐NET Co‐fund action no. 680969 (ERA‐CVD DETECTIN‐HF), jointly funded by the Dutch Heart Foundation (2016T096), and Netherlands Organization for Health Research and Development (ZonMw). A.S. is funded by the Alexandre Suerman Stipendium. A.T.R. is funded by the Dutch Heart Foundation (2015T058), the UMC Utrecht Fellowship Clinical Research Talent and CVON 2015‐12 eDETECT. E.K. is partially funded by the German Centre for Cardiovascular Research, DZHK (81X3500117). F.A. is supported by UCL Hospitals NIHR Biomedical Research and CVON 2015‐12 eDETECT.
Funding Information:
This project received funding from the European Union's Horizon 2020 research and innovation programme under the ERA-NET Co-fund action no. 680969 (ERA-CVD DETECTIN-HF), jointly funded by the Dutch Heart Foundation (2016T096), and Netherlands Organization for Health Research and Development (ZonMw). A.S. is funded by the Alexandre Suerman Stipendium. A.T.R. is funded by the Dutch Heart Foundation (2015T058), the UMC Utrecht Fellowship Clinical Research Talent and CVON 2015-12 eDETECT. E.K. is partially funded by the German Centre for Cardiovascular Research, DZHK (81X3500117). F.A. is supported by UCL Hospitals NIHR Biomedical Research and CVON 2015-12 eDETECT. We would like to thank all collaborators in the ERA-CVD DETECTIN-HF programme.
Publisher Copyright:
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology
PY - 2020/8
Y1 - 2020/8
N2 - AIMS: Patients with non-ischaemic dilated cardiomyopathy (DCM) are at increased risk of sudden cardiac death. Identification of patients that may benefit from implantable cardioverter-defibrillator implantation remains challenging. In this study, we aimed to determine predictors of sustained ventricular arrhythmias in patients with DCM.METHODS AND RESULTS: We searched MEDLINE/Embase for studies describing predictors of sustained ventricular arrhythmias in patients with DCM. Quality and bias were assessed using the Quality in Prognostic Studies tool, articles with high risk of bias in ≥2 areas were excluded. Unadjusted hazard ratios (HRs) of uniformly defined predictors were pooled, while all other predictors were evaluated in a systematic review. We included 55 studies (11 451 patients and 3.7 ± 2.3 years follow-up). Crude annual event rate was 4.5%. Younger age [HR 0.82; 95% CI (0.74-1.00)], hypertension [HR 1.95; 95% CI (1.26-3.00)], prior sustained ventricular arrhythmia [HR 4.15; 95% CI (1.32-13.02)], left ventricular ejection fraction on ultrasound [HR 1.45; 95% CI (1.19-1.78)], left ventricular dilatation (HR 1.10), and presence of late gadolinium enhancement [HR 5.55; 95% CI (4.02-7.67)] were associated with arrhythmic outcome in pooled analyses. Prior non-sustained ventricular arrhythmia and several genotypes [mutations in Phospholamban (PLN), Lamin A/C (LMNA), and Filamin-C (FLNC)] were associated with arrhythmic outcome in non-pooled analyses. Quality of evidence was moderate, and heterogeneity among studies was moderate to high.CONCLUSIONS: In patients with DCM, the annual event rate of sustained ventricular arrhythmias is approximately 4.5%. This risk is considerably higher in younger patients with hypertension, prior (non-)sustained ventricular arrhythmia, decreased left ventricular ejection fraction, left ventricular dilatation, late gadolinium enhancement, and genetic mutations (PLN, LMNA, and FLNC). These results may help determine appropriate candidates for implantable cardioverter-defibrillator implantation.
AB - AIMS: Patients with non-ischaemic dilated cardiomyopathy (DCM) are at increased risk of sudden cardiac death. Identification of patients that may benefit from implantable cardioverter-defibrillator implantation remains challenging. In this study, we aimed to determine predictors of sustained ventricular arrhythmias in patients with DCM.METHODS AND RESULTS: We searched MEDLINE/Embase for studies describing predictors of sustained ventricular arrhythmias in patients with DCM. Quality and bias were assessed using the Quality in Prognostic Studies tool, articles with high risk of bias in ≥2 areas were excluded. Unadjusted hazard ratios (HRs) of uniformly defined predictors were pooled, while all other predictors were evaluated in a systematic review. We included 55 studies (11 451 patients and 3.7 ± 2.3 years follow-up). Crude annual event rate was 4.5%. Younger age [HR 0.82; 95% CI (0.74-1.00)], hypertension [HR 1.95; 95% CI (1.26-3.00)], prior sustained ventricular arrhythmia [HR 4.15; 95% CI (1.32-13.02)], left ventricular ejection fraction on ultrasound [HR 1.45; 95% CI (1.19-1.78)], left ventricular dilatation (HR 1.10), and presence of late gadolinium enhancement [HR 5.55; 95% CI (4.02-7.67)] were associated with arrhythmic outcome in pooled analyses. Prior non-sustained ventricular arrhythmia and several genotypes [mutations in Phospholamban (PLN), Lamin A/C (LMNA), and Filamin-C (FLNC)] were associated with arrhythmic outcome in non-pooled analyses. Quality of evidence was moderate, and heterogeneity among studies was moderate to high.CONCLUSIONS: In patients with DCM, the annual event rate of sustained ventricular arrhythmias is approximately 4.5%. This risk is considerably higher in younger patients with hypertension, prior (non-)sustained ventricular arrhythmia, decreased left ventricular ejection fraction, left ventricular dilatation, late gadolinium enhancement, and genetic mutations (PLN, LMNA, and FLNC). These results may help determine appropriate candidates for implantable cardioverter-defibrillator implantation.
KW - Dilated cardiomyopathy
KW - Implantable cardiac-defibrillator
KW - Prognosis
KW - Risk
KW - Sudden cardiac death
UR - https://www.scopus.com/pages/publications/85083443394
U2 - 10.1002/ehf2.12689
DO - 10.1002/ehf2.12689
M3 - Review article
C2 - 32285648
SN - 2055-5822
VL - 7
SP - 1430
EP - 1441
JO - ESC heart failure
JF - ESC heart failure
IS - 4
ER -