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DOI: 10.31071/kit2014.11.03

Inventory reference ISSN 1812-7231 Klin.inform.telemed. Volume 10, Issue 11, 2014, Pages 32–38

Author(s) A.V.Frolov1, T.G.Vaikhanskaya1, M.A.Martsennyuk2

Institution(s) 1Republican Scientific and Practical Centre "Cardiology", Minsk, Belarus 2Perm State National Research University, Perm, Russia

Article title Cardiovascular risk events in perspective catastrophe theory

Abstract (resume)

Introduction. Prognosis of sudden cardiac death (SCD ) of the arrhythmogenic origin is a difficult task. Criterion based on low ejection fraction and ventricular arrhythmia gives a high percentage of false-positive decisions when implanted cardioverter — defibrillators (ICD). Therefore, the search for objective ICD for patients is relevant.

Purpose. The objective of this study was to develop a risk stratification algorithm for patients with cardiomyopathy for timely ICD in case of the high risk of SCD.

Material and methods. We examined 240 patients with cardiomyopathy, the time of observation was 27,8±5,7 months. Adverse cardiovascular events (SCD, ventricular tachycardia, episodes of shock therapy) recorded. Markers of the myocardial electric instability (T wave alternans, duration and dispersion QT, heart rate turbulence) and left ventricular ejection fraction measured.

Results and discussion. In patients with cardiomyopathy, low ejection fraction (<23,5%) in combination with high T wave alternans (>35,5 γV) and abnormal heart rate turbulence (TO>1,3%) predicts a high risk of ventricular tachycardia/SCD RR=7,23, 95% CI{2,2–28,5}, p=0,000. The sensitivity of these markers is from 83 to 90% , a specificity is from 70 to 80 %. The risk-stratification algorithm of patients with the purpose of selecting candidates for the ICD was developed. Approach phases to cardiovascular catastrophe presented.

Conclusion. The study showed that markers of myocardial electric instability in combination with ejection fraction significantly improve the prognosis of patients with cardiomyopathy, timely and objective ICD reduces the frequency of 4 SCD.

Keywords Catastrophe theory; Heart rate turbulence; QT dispersion; Sudden cardiac death; T wave alternans


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