Left ventricular dilatation increases the risk of ventricular arrhythmias in patients with reduced systolic function

Ryan G. Aleong; Matthew J. Mulvahill; Indrani Halder; Nichole E. Carlson; Madhurmeet Singh; Heather L. Bloom; Samuel C. Dudley; Patrick T. Ellinor; Alaa Shalaby; Raul Weiss; Rebecca Gutmann; William H. Sauer; Kumar Narayanan; Sumeet S. Chugh; Samir Saba; Barry London

doi:10.1161/JAHA.114.001566

Left ventricular dilatation increases the risk of ventricular arrhythmias in patients with reduced systolic function

Ryan G. Aleong, Matthew J. Mulvahill, Indrani Halder, Nichole E. Carlson, Madhurmeet Singh, Heather L. Bloom, Samuel C. Dudley, Patrick T. Ellinor, Alaa Shalaby, Raul Weiss, Rebecca Gutmann, William H. Sauer, Kumar Narayanan, Sumeet S. Chugh, Samir Saba, Barry London

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

Background-—Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. Methods and Results-—Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV enddiastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009). Conclusions-—LV dilatation may complement ejection fraction to predict ventricular arrhythmias.

Original language	English (US)
Article number	e001566
Journal	Journal of the American Heart Association
Volume	4
Issue number	8
DOIs	https://doi.org/10.1161/JAHA.114.001566
State	Published - 2015

Bibliographical note

Funding Information:
This study was supported by National Institutes of Health (NIH)–National Heart, Lung, and Blood Institute (NHLBI) R01 HL77398 (Dr London, PI) NIH-NHLBI R01 HL103946 (Dr Cheng, PI), and NIH-NCATS UL1 TR001082 (Drs Mulvahill and Carlson).

Publisher Copyright:
© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Keywords

Heart failure
Ventricular arrhythmias

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Aleong, R. G., Mulvahill, M. J., Halder, I., Carlson, N. E., Singh, M., Bloom, H. L., Dudley, S. C., Ellinor, P. T., Shalaby, A., Weiss, R., Gutmann, R., Sauer, W. H., Narayanan, K., Chugh, S. S., Saba, S., & London, B. (2015). Left ventricular dilatation increases the risk of ventricular arrhythmias in patients with reduced systolic function. Journal of the American Heart Association, 4(8), Article e001566. https://doi.org/10.1161/JAHA.114.001566

Aleong, RG, Mulvahill, MJ, Halder, I, Carlson, NE, Singh, M, Bloom, HL, Dudley, SC, Ellinor, PT, Shalaby, A, Weiss, R, Gutmann, R, Sauer, WH, Narayanan, K, Chugh, SS, Saba, S & London, B 2015, 'Left ventricular dilatation increases the risk of ventricular arrhythmias in patients with reduced systolic function', Journal of the American Heart Association, vol. 4, no. 8, e001566. https://doi.org/10.1161/JAHA.114.001566

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title = "Left ventricular dilatation increases the risk of ventricular arrhythmias in patients with reduced systolic function",

abstract = "Background-—Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. Methods and Results-—Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV enddiastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009). Conclusions-—LV dilatation may complement ejection fraction to predict ventricular arrhythmias.",

keywords = "Heart failure, Ventricular arrhythmias",

author = "Aleong, {Ryan G.} and Mulvahill, {Matthew J.} and Indrani Halder and Carlson, {Nichole E.} and Madhurmeet Singh and Bloom, {Heather L.} and Dudley, {Samuel C.} and Ellinor, {Patrick T.} and Alaa Shalaby and Raul Weiss and Rebecca Gutmann and Sauer, {William H.} and Kumar Narayanan and Chugh, {Sumeet S.} and Samir Saba and Barry London",

note = "Funding Information: This study was supported by National Institutes of Health (NIH)–National Heart, Lung, and Blood Institute (NHLBI) R01 HL77398 (Dr London, PI) NIH-NHLBI R01 HL103946 (Dr Cheng, PI), and NIH-NCATS UL1 TR001082 (Drs Mulvahill and Carlson). Publisher Copyright: {\textcopyright} 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.",

year = "2015",

doi = "10.1161/JAHA.114.001566",

language = "English (US)",

volume = "4",

journal = "Journal of the American Heart Association",

issn = "2047-9980",

publisher = "Wiley-Blackwell",

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TY - JOUR

T1 - Left ventricular dilatation increases the risk of ventricular arrhythmias in patients with reduced systolic function

AU - Aleong, Ryan G.

AU - Mulvahill, Matthew J.

AU - Halder, Indrani

AU - Carlson, Nichole E.

AU - Singh, Madhurmeet

AU - Bloom, Heather L.

AU - Dudley, Samuel C.

AU - Ellinor, Patrick T.

AU - Shalaby, Alaa

AU - Weiss, Raul

AU - Gutmann, Rebecca

AU - Sauer, William H.

AU - Narayanan, Kumar

AU - Chugh, Sumeet S.

AU - Saba, Samir

AU - London, Barry

N1 - Funding Information: This study was supported by National Institutes of Health (NIH)–National Heart, Lung, and Blood Institute (NHLBI) R01 HL77398 (Dr London, PI) NIH-NHLBI R01 HL103946 (Dr Cheng, PI), and NIH-NCATS UL1 TR001082 (Drs Mulvahill and Carlson). Publisher Copyright: © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

PY - 2015

Y1 - 2015

N2 - Background-—Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. Methods and Results-—Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV enddiastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009). Conclusions-—LV dilatation may complement ejection fraction to predict ventricular arrhythmias.

AB - Background-—Reduced left ventricular (LV) ejection fraction increases the risk of ventricular arrhythmias; however, LV ejection fraction has a low sensitivity to predict ventricular arrhythmias. LV dilatation and mass may be useful to further risk-stratify for ventricular arrhythmias. Methods and Results-—Patients from the Genetic Risk of Assessment of Defibrillator Events (GRADE) study (N=930), a study of heart failure subjects with defibrillators, were assessed for appropriate implantable cardioverter-defibrillator shock and death, heart transplant, or ventricular assist device placement by LV diameter and mass. LV mass was divided into normal, mild, moderate, and severe classifications. Severe LV end-diastolic diameter had worse shock-free survival than normal and mild LV enddiastolic diameter (P=0.0002 and 0.0063, respectively; 2-year shock free, severe 74%, moderate 80%, mild 91%, normal 88%; 4-year shock free, severe 62%, moderate 69%, mild 72%, normal 81%) and freedom from death, transplant, or ventricular assist device compared with normal and moderate LV end-diastolic diameter (P<0.0001 and 0.0441, respectively; 2-year survival: severe 78%, moderate 85%, mild 82%, normal 89%; 4-year survival: severe 55%, moderate 64%, mild 63%, normal 74%). Severe LV mass had worse shock-free survival than normal and mild LV mass (P=0.0370 and 0.0280, respectively; 2-year shock free: severe 80%, moderate 81%, mild 91%, normal 87%; 4-year shock free: severe 68%, moderate 73%, mild 76%, normal 76%) but no association with death, transplant, or ventricular assist device (P=0.1319). In a multivariable Cox proportional hazards analysis adjusted for LV ejection fraction, LV end-diastolic diameter was associated with appropriate implantable cardioverter-defibrillator shocks (hazard ratio 1.22, P=0.020). LV end-diastolic diameter was associated with time to death, transplant, or ventricular assist device (hazard ratio 1.29, P=0.0009). Conclusions-—LV dilatation may complement ejection fraction to predict ventricular arrhythmias.

KW - Heart failure

KW - Ventricular arrhythmias

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DO - 10.1161/JAHA.114.001566

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C2 - 26231842

AN - SCOPUS:84977944469

SN - 2047-9980

VL - 4

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 8

M1 - e001566

ER -

Left ventricular dilatation increases the risk of ventricular arrhythmias in patients with reduced systolic function

Abstract

Bibliographical note

Keywords

UN SDGs

Access

OpenUrl availability

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