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Periodic Repolarization Dynamics Identifies ICD-responders in Non-ischemic Cardiomyopathy: A DANISH Substudy

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Boas, R, Sappler, N, von Stülpnagel, L, Klemm, M, Dixen, U, Thune, JJ, Pehrson, S, Køber, L, Nielsen, JC, Videbæk, L, Haarbo, J, Korup, E, Bruun, NE, Brandes, A, Eiskjaer, H, Thøgersen, AM, Philbert, BT, Svendsen, JH, Tfelt-Hansen, J, Bauer, A & Rizas, KD 2022, 'Periodic Repolarization Dynamics Identifies ICD-responders in Non-ischemic Cardiomyopathy: A DANISH Substudy', Circulation, bind 145, nr. 10, 056464, s. 754-764. https://doi.org/10.1161/CIRCULATIONAHA.121.056464

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Boas, Rune ; Sappler, Nikolay ; von Stülpnagel, Lukas ; Klemm, Mathias ; Dixen, Ulrik ; Thune, Jens Jakob ; Pehrson, Steen ; Køber, Lars ; Nielsen, Jens C ; Videbæk, Lars ; Haarbo, Jens ; Korup, Eva ; Bruun, Niels Eske ; Brandes, Axel ; Eiskjaer, Hans ; Thøgersen, Anna M ; Philbert, Berit T ; Svendsen, Jesper Hastrup ; Tfelt-Hansen, Jacob ; Bauer, Axel ; Rizas, Konstantinos D. / Periodic Repolarization Dynamics Identifies ICD-responders in Non-ischemic Cardiomyopathy : A DANISH Substudy. I: Circulation. 2022 ; Bind 145, Nr. 10. s. 754-764.

Bibtex

@article{6df3bd2cffbd4522a8cfb601f5bc83a3,
title = "Periodic Repolarization Dynamics Identifies ICD-responders in Non-ischemic Cardiomyopathy: A DANISH Substudy",
abstract = "BACKGROUND: Identification of patients with nonischemic cardiomyopathy who may benefit from prophylactic implantation of a cardioverter-defibrillator. We hypothesized that periodic repolarization dynamics (PRD), a marker of repolarization instability associated with sympathetic activity, could be used to identify patients who will benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation.METHODS: We performed a post hoc analysis of DANISH (Danish ICD Study in Patients With Dilated Cardiomyopathy), in which patients with nonischemic cardiomyopathy, left ventricular ejection fraction (LVEF) ≤35%, and elevated NT-proBNP (N-terminal probrain natriuretic peptides) were randomized to ICD implantation or control group. Patients were included in the PRD substudy if they had a 24-hour Holter monitor recording at baseline with technically acceptable ECG signals during the night hours (00:00-06:00). PRD was assessed using wavelet analysis according to previously validated methods. The primary end point was all-cause mortality. Cox regression models were adjusted for age, sex, NT-proBNP, estimated glomerular filtration rate, LVEF, atrial fibrillation, ventricular pacing, diabetes, cardiac resynchronization therapy, and mean heart rate. We proposed PRD ≥10 deg2 as an exploratory cut-off value for ICD implantation.RESULTS: A total of 748 of the 1116 patients in DANISH qualified for the PRD substudy. During a mean follow-up period of 5.1±2.0 years, 82 of 385 patients died in the ICD group and 85 of 363 patients died in the control group (P=0.40). In Cox regression analysis, PRD was independently associated with mortality (hazard ratio [HR], 1.28 [95% CI, 1.09-1.50] per SD increase; P=0.003). PRD was significantly associated with mortality in the control group (HR, 1.51 [95% CI, 1.25-1.81]; P<0.001) but not in the ICD group (HR, 1.04 [95% CI, 0.83-1.54]; P=0.71). There was a significant interaction between PRD and the effect of ICD implantation on mortality (P=0.008), with patients with higher PRD having greater benefit in terms of mortality reduction. ICD implantation was associated with an absolute mortality reduction of 17.5% in the 280 patients with PRD ≥10 deg2 (HR, 0.54 [95% CI, 0.34-0.84]; P=0.006; number needed to treat=6), but not in the 468 patients with PRD <10 deg2 (HR, 1.17 [95% CI, 0.77-1.78]; P=0.46; P for interaction=0.01).CONCLUSIONS: Increased PRD identified patients with nonischemic cardiomyopathy in whom prophylactic ICD implantation led to significant mortality reduction.",
keywords = "cardiomyopath, death, sudden, defibrillators, implantable, ies, risk",
author = "Rune Boas and Nikolay Sappler and {von St{\"u}lpnagel}, Lukas and Mathias Klemm and Ulrik Dixen and Thune, {Jens Jakob} and Steen Pehrson and Lars K{\o}ber and Nielsen, {Jens C} and Lars Videb{\ae}k and Jens Haarbo and Eva Korup and Bruun, {Niels Eske} and Axel Brandes and Hans Eiskjaer and Th{\o}gersen, {Anna M} and Philbert, {Berit T} and Svendsen, {Jesper Hastrup} and Jacob Tfelt-Hansen and Axel Bauer and Rizas, {Konstantinos D}",
year = "2022",
month = mar,
day = "8",
doi = "10.1161/CIRCULATIONAHA.121.056464",
language = "English",
volume = "145",
pages = "754--764",
journal = "Circulation (Baltimore)",
issn = "0009-7322",
publisher = "Lippincott Williams & Wilkins",
number = "10",

}

RIS

TY - JOUR

T1 - Periodic Repolarization Dynamics Identifies ICD-responders in Non-ischemic Cardiomyopathy

T2 - A DANISH Substudy

AU - Boas, Rune

AU - Sappler, Nikolay

AU - von Stülpnagel, Lukas

AU - Klemm, Mathias

AU - Dixen, Ulrik

AU - Thune, Jens Jakob

AU - Pehrson, Steen

AU - Køber, Lars

AU - Nielsen, Jens C

AU - Videbæk, Lars

AU - Haarbo, Jens

AU - Korup, Eva

AU - Bruun, Niels Eske

AU - Brandes, Axel

AU - Eiskjaer, Hans

AU - Thøgersen, Anna M

AU - Philbert, Berit T

AU - Svendsen, Jesper Hastrup

AU - Tfelt-Hansen, Jacob

AU - Bauer, Axel

AU - Rizas, Konstantinos D

PY - 2022/3/8

Y1 - 2022/3/8

N2 - BACKGROUND: Identification of patients with nonischemic cardiomyopathy who may benefit from prophylactic implantation of a cardioverter-defibrillator. We hypothesized that periodic repolarization dynamics (PRD), a marker of repolarization instability associated with sympathetic activity, could be used to identify patients who will benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation.METHODS: We performed a post hoc analysis of DANISH (Danish ICD Study in Patients With Dilated Cardiomyopathy), in which patients with nonischemic cardiomyopathy, left ventricular ejection fraction (LVEF) ≤35%, and elevated NT-proBNP (N-terminal probrain natriuretic peptides) were randomized to ICD implantation or control group. Patients were included in the PRD substudy if they had a 24-hour Holter monitor recording at baseline with technically acceptable ECG signals during the night hours (00:00-06:00). PRD was assessed using wavelet analysis according to previously validated methods. The primary end point was all-cause mortality. Cox regression models were adjusted for age, sex, NT-proBNP, estimated glomerular filtration rate, LVEF, atrial fibrillation, ventricular pacing, diabetes, cardiac resynchronization therapy, and mean heart rate. We proposed PRD ≥10 deg2 as an exploratory cut-off value for ICD implantation.RESULTS: A total of 748 of the 1116 patients in DANISH qualified for the PRD substudy. During a mean follow-up period of 5.1±2.0 years, 82 of 385 patients died in the ICD group and 85 of 363 patients died in the control group (P=0.40). In Cox regression analysis, PRD was independently associated with mortality (hazard ratio [HR], 1.28 [95% CI, 1.09-1.50] per SD increase; P=0.003). PRD was significantly associated with mortality in the control group (HR, 1.51 [95% CI, 1.25-1.81]; P<0.001) but not in the ICD group (HR, 1.04 [95% CI, 0.83-1.54]; P=0.71). There was a significant interaction between PRD and the effect of ICD implantation on mortality (P=0.008), with patients with higher PRD having greater benefit in terms of mortality reduction. ICD implantation was associated with an absolute mortality reduction of 17.5% in the 280 patients with PRD ≥10 deg2 (HR, 0.54 [95% CI, 0.34-0.84]; P=0.006; number needed to treat=6), but not in the 468 patients with PRD <10 deg2 (HR, 1.17 [95% CI, 0.77-1.78]; P=0.46; P for interaction=0.01).CONCLUSIONS: Increased PRD identified patients with nonischemic cardiomyopathy in whom prophylactic ICD implantation led to significant mortality reduction.

AB - BACKGROUND: Identification of patients with nonischemic cardiomyopathy who may benefit from prophylactic implantation of a cardioverter-defibrillator. We hypothesized that periodic repolarization dynamics (PRD), a marker of repolarization instability associated with sympathetic activity, could be used to identify patients who will benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation.METHODS: We performed a post hoc analysis of DANISH (Danish ICD Study in Patients With Dilated Cardiomyopathy), in which patients with nonischemic cardiomyopathy, left ventricular ejection fraction (LVEF) ≤35%, and elevated NT-proBNP (N-terminal probrain natriuretic peptides) were randomized to ICD implantation or control group. Patients were included in the PRD substudy if they had a 24-hour Holter monitor recording at baseline with technically acceptable ECG signals during the night hours (00:00-06:00). PRD was assessed using wavelet analysis according to previously validated methods. The primary end point was all-cause mortality. Cox regression models were adjusted for age, sex, NT-proBNP, estimated glomerular filtration rate, LVEF, atrial fibrillation, ventricular pacing, diabetes, cardiac resynchronization therapy, and mean heart rate. We proposed PRD ≥10 deg2 as an exploratory cut-off value for ICD implantation.RESULTS: A total of 748 of the 1116 patients in DANISH qualified for the PRD substudy. During a mean follow-up period of 5.1±2.0 years, 82 of 385 patients died in the ICD group and 85 of 363 patients died in the control group (P=0.40). In Cox regression analysis, PRD was independently associated with mortality (hazard ratio [HR], 1.28 [95% CI, 1.09-1.50] per SD increase; P=0.003). PRD was significantly associated with mortality in the control group (HR, 1.51 [95% CI, 1.25-1.81]; P<0.001) but not in the ICD group (HR, 1.04 [95% CI, 0.83-1.54]; P=0.71). There was a significant interaction between PRD and the effect of ICD implantation on mortality (P=0.008), with patients with higher PRD having greater benefit in terms of mortality reduction. ICD implantation was associated with an absolute mortality reduction of 17.5% in the 280 patients with PRD ≥10 deg2 (HR, 0.54 [95% CI, 0.34-0.84]; P=0.006; number needed to treat=6), but not in the 468 patients with PRD <10 deg2 (HR, 1.17 [95% CI, 0.77-1.78]; P=0.46; P for interaction=0.01).CONCLUSIONS: Increased PRD identified patients with nonischemic cardiomyopathy in whom prophylactic ICD implantation led to significant mortality reduction.

KW - cardiomyopath

KW - death, sudden

KW - defibrillators, implantable

KW - ies

KW - risk

UR - http://www.scopus.com/inward/record.url?scp=85125965728&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.121.056464

DO - 10.1161/CIRCULATIONAHA.121.056464

M3 - Journal article

C2 - 34889650

VL - 145

SP - 754

EP - 764

JO - Circulation (Baltimore)

JF - Circulation (Baltimore)

SN - 0009-7322

IS - 10

M1 - 056464

ER -

ID: 71197675