Prognostic impact of left ventricular ejection fraction in patients with electrical storm
The study sought to assess retrospectively the prognostic impact of left ventricular ejection fraction (LVEF) in patients with electrical storm (ES).
Data regarding the prognostic impact of impaired LVEF in ES patients is rare.
Consecutive patients presenting with ES from 2002 to 2016 were included retrospectively. Patients with LVEF ≤ 35% were compared to patients with LVEF > 35%. The primary prognostic endpoint was long-term all-cause mortality, and secondary endpoints were rates of in-hospital mortality, rehospitalization, major adverse cardiac events (MACE), and ES recurrences (ES-R) at long-term follow-up.
A total of 80 patients with ES were included at 2.5 years of follow-up. 69% of patients suffered from LVEF ≤ 35%. ES patients with LVEF ≤ 35% were associated with higher rates of the primary endpoint of all-cause mortality (53% versus 8%, log-rank p = 0.0001; HR 8.524; 95% CI 2.030–35.793, p = 0.003), as well as the secondary endpoints of MACE (53% versus 20%; log rank p = 0.011; HR 3.213, 95% CI 1.241–8.316, p = 0.016) and ES-R (35% versus 8%; log rank p = 0.019; HR 4.821, 95% CI 1.122–20.706, p = 0.034). Furthermore, ES patients with LVEF ≤ 35% showed higher rates of rehospitalization due to acute heart failure (24% versus 8%, statistical trend p = 0.096). Notably, ES patients with LVEF > 35% were associated with increased rates of rehospitalization due to ventricular tachycardia (36% versus 18%, statistical trend p = 0.083).
ES patients with LVEF ≤ 35% were associated with increased rates of all-cause mortality, MACE, ES-R and heart failure-related rehospitalization at long-term follow-up.
This study evaluated retrospectively the prognostic impact of LVEF in patients with ES. LVEF ≤ 35% was associated with increased long-term all-cause mortality (53% versus 8%; HR 8.524; 95% CI 2.030–35.793, p = 0.003), MACE (53% versus 20%; HR 3.213, 95% CI 1.241–8.316, p = 0.016), and ES recurrences (35% versus 8%; HR 4.821, 95% CI 1.122–20.706, p = 0.034), while trends were observed for higher rates of heart-failure related rehospitalization (24% versus 8%, p = 0.096) and MACE (49% versus 28%; p = 0.081).
KeywordsAcute heart failure Left ventricular ejection fraction Electrical storm Heart failure Sudden cardiac death MACE Mortality Hospitalization
The study was supported by the DZHK (Deutsches Zentrum fuer Herz-Kreislauf-Forschung - German Centre for Cardiovascular Research).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study is based on a retrospective data analysis/ registry and has been approved by the local ethics commission II of the Faculty of Medicine Mannheim, University of Heidelberg, where no informed consent was deemed necessary for this study (ethical approval number 2016-612NMA) (clinicaltrials.gov identifier: NCT02982473).
- 8.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the heart failure association (HFA) of the ESC. Eur J Heart Fail. 2016;18(8):891–975.CrossRefPubMedGoogle Scholar
- 9.McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. Eur Heart J. 2012;33(14):1787–847.CrossRefPubMedGoogle Scholar
- 11.Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the task force for the Management of Patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793–867.CrossRefPubMedGoogle Scholar
- 14.Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2017;18(12):1301–10.CrossRefPubMedGoogle Scholar
- 18.Kim M, Kim J, Lee JH, Hwang YM, Kim MS, Nam GB, et al. Impact of improved left ventricular systolic function on the recurrence of ventricular arrhythmia in heart failure patients with an implantable cardioverter-defibrillator. J Cardiovasc Electrophysiol. 2016;27(10):1191–8.CrossRefPubMedGoogle Scholar
- 19.Ruwald MH, Solomon SD, Foster E, Kutyifa V, Ruwald AC, Sherazi S, et al. Left ventricular ejection fraction normalization in cardiac resynchronization therapy and risk of ventricular arrhythmias and clinical outcomes: results from the multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-CRT) trial. Circulation. 2014;130(25):2278–86.CrossRefPubMedGoogle Scholar
- 20.Smer A, Saurav A, Azzouz MS, Salih M, Ayan M, Abuzaid A, et al. Meta-analysis of risk of ventricular arrhythmias after improvement in left ventricular ejection fraction during follow-up in patients with primary prevention implantable cardioverter defibrillators. Am J Cardiol. 2017;120(2):279–86.CrossRefPubMedGoogle Scholar
- 26.Hayashi K, Heeger C-H, Mathew S, Maurer T, Lemes C, Riedl J, Reißmann B, Frerker C, Geidel S, Schmoeckel M, Saguner AM, Santoro F, Tilz RR, Metzner A, Kuck K-H, Ouyang F (2018) Antegrade-transseptal approach for left ventricular tachyarrhythmia in patients with previous Mitraclip implantation. EP Europace 20(9):1527–1534Google Scholar