1. A prognostic index for risk stratification for acute heart failure and death in subjects with ischemic cardiomyopathy and cardiac defibrillator.
- Author
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Antonini L, Mollica C, Auriti A, Pristipino C, Pasceri V, Leone F, and Greco S
- Subjects
- Acute Disease, Aged, Biomarkers blood, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Cardiomyopathies diagnosis, Cardiomyopathies etiology, Cardiomyopathies mortality, Cardiomyopathies physiopathology, Creatinine blood, Female, Heart Failure diagnosis, Heart Failure etiology, Heart Failure mortality, Heart Failure physiopathology, Heart Rate, Hospitalization, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Myocardial Ischemia diagnosis, Myocardial Ischemia mortality, Myocardial Ischemia physiopathology, Predictive Value of Tests, Proportional Hazards Models, Prospective Studies, Risk Assessment, Risk Factors, Sodium blood, Stroke Volume, Time Factors, Treatment Outcome, Ventricular Function, Left, Cardiomyopathies therapy, Decision Support Techniques, Defibrillators, Implantable, Electric Countershock instrumentation, Heart Failure therapy, Models, Biological, Myocardial Ischemia complications
- Abstract
To propose a clinical prognostic index for death and heart failure in patients with ischemic cardiomyopathy implanted with an ICD. This prospective study included 192 consecutive patients (age 68 ± 10) recruited from 2004 to 2009 and implanted with an ICD for MADIT II criteria. All patients performed 24-h ambulatory blood pressure monitoring after discharge and common haematological samples. The prognostic index (PI) was built according to the formula: 120 - age + mean 24 h systolic blood pressure--(creatinine 9 10). Other variables were assessed: EF, haemoglobin concentration, mean 24 h heart rate and diastolic blood pressure, sodium level, pacing mode and diabetes. Non-arrhythmic cardiac death and new hospitalizations for heart failure during 1-year follow-up were the combined end point. A total of 48 events (25%) occurred during the follow-up: 7 cardiac deaths and 41 hospitalizations for acute heart failure. Cox proportional hazards model showed that PI was the only predictor of events (HR = 0.96; CI 95% 0.944–0.976, p < 0.0001). ROC curve showed that PI best cut-off was 144, with AUC 0.79, p < 0.0001; sensitivity 77%, specificity 74%, positive predictive value 50%, negative predictive value 90%. PI was predictive of events in a clinical setting where EF had no predictive value. PI works according to the rule ‘‘the lower the worse’’. The high negative predictive value (90%) of PI allows to identify subjects at lower risk for death and heart failure. PI can be a practical tool to stratify risk in ischemic cardiomyopathy.
- Published
- 2015
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