Predictors of arrhythmic sudden cardiac death in heart failure patients in the CARE-HF study

TY - GEN

T1 - Predictors of arrhythmic sudden cardiac death in heart failure patients in the CARE-HF study

AU - Uretsky, B.

AU - Cleland, J.G.F.

AU - Freemantle, N.

AU - Daubert, J.C.

AU - Gras, D.

AU - Kappenberger, L.

AU - Tavazzi, L.

AU - Thygesen, Kristian Anton

N1 - Udgave: http://www.escardio.org/knowledge/congresses/abol/presentation?id=38649

PY - 2006

Y1 - 2006

N2 - Topic(s):Rsynchronisation therapy Cardiac resynchronization therapy (CRT) has become an important modality to improve symptoms, exercise performance, and survival in patients with severe heart failure and left ventricular dyssynchrony. The CARE-HF study showed that CRT reduced mortality in systolic heart failure (HF) patients with ventricular dyssynchrony by 10% (relative reduction 36%) during a mean follow-up of 29.4 months, primarily because of fewer heart failure deaths but without a significant decrease in presumed arrhythmic sudden cardiac deaths (SCD). In the pre-planned extension phase (mean follow-up 36.4 months), SCDs were significantly reduced in the CRT group.Methods: We performed an analysis on 813 patients to determine factors predicting SCD during long-term follow-up using parameters at baseline and at the prespecified 3 month examination.Results: Of 255 deaths, 89% occurred after 3 months. Univariate SCD predictors [hazard ratio (HR), 95% confidence interval (CI)] included randomization to CRT HR 0.47 (CI 0.29 to 0.76) and 3 month level of mitral regurgitation (MR) 1.89 (1.32 to 2.70), BNP 1.38 (1.14 to 1.66), and echo EDVI 1.002 (1.001 to 1.004). The only predictors of SCD on multivariable analysis were the severity of MR at 3 months 1.85 (1.77 to 2.60) and randomization to CRT 0.56 (0.53 to 0.96).Conclusions: Compared with best medical therapy, CRT significantly decreases, but does not abolish, long-term risk of SCD in patients with severe heart failure. The analysis supports the concept that it is the improvement in cardiac function with CRT that leads to the reduction in lethal arrhythmias and SCD.

AB - Topic(s):Rsynchronisation therapy Cardiac resynchronization therapy (CRT) has become an important modality to improve symptoms, exercise performance, and survival in patients with severe heart failure and left ventricular dyssynchrony. The CARE-HF study showed that CRT reduced mortality in systolic heart failure (HF) patients with ventricular dyssynchrony by 10% (relative reduction 36%) during a mean follow-up of 29.4 months, primarily because of fewer heart failure deaths but without a significant decrease in presumed arrhythmic sudden cardiac deaths (SCD). In the pre-planned extension phase (mean follow-up 36.4 months), SCDs were significantly reduced in the CRT group.Methods: We performed an analysis on 813 patients to determine factors predicting SCD during long-term follow-up using parameters at baseline and at the prespecified 3 month examination.Results: Of 255 deaths, 89% occurred after 3 months. Univariate SCD predictors [hazard ratio (HR), 95% confidence interval (CI)] included randomization to CRT HR 0.47 (CI 0.29 to 0.76) and 3 month level of mitral regurgitation (MR) 1.89 (1.32 to 2.70), BNP 1.38 (1.14 to 1.66), and echo EDVI 1.002 (1.001 to 1.004). The only predictors of SCD on multivariable analysis were the severity of MR at 3 months 1.85 (1.77 to 2.60) and randomization to CRT 0.56 (0.53 to 0.96).Conclusions: Compared with best medical therapy, CRT significantly decreases, but does not abolish, long-term risk of SCD in patients with severe heart failure. The analysis supports the concept that it is the improvement in cardiac function with CRT that leads to the reduction in lethal arrhythmias and SCD.

M3 - Article in proceedings

BT - Ikke angivet

PB - European Society of Cardiology

T2 - World Congress of Cardiology 2006

Y2 - 2 September 2006 through 6 September 2006

ER -