Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy
Background Risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is mainly based on evaluations from patients at highly specialized centers. Aim To evaluate risk markers for appropriate implantable cardioverter defibrillator (ICD) therapy in an unselected, nationwide...
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| Veröffentlicht in: | Pacing and clinical electrophysiology 2016-03, Vol.39 (3), p.291-301 |
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| description | Background
Risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is mainly based on evaluations from patients at highly specialized centers.
Aim
To evaluate risk markers for appropriate implantable cardioverter defibrillator (ICD) therapy in an unselected, nationwide cohort of HCM.
Methods
Patients with an ICD due to HCM were identified from the Swedish ICD Registry since its start in 1995, merged with Patient Register data, and medical records were retrieved. Risk markers for ventricular arrhythmias leading to appropriate ICD therapy were analyzed using Cox proportional hazard ratio (HR).
Results
Of 321 patients (70.1% males), at least one appropriate therapy occurred in 77 (24.0%) during a mean follow‐up of 5.4 years (5.3% per year; primary prevention 4.5%, secondary prevention 7.0%). Cumulative incidences at 1 year, 3 years, and 5 years were 8.1%, 15.3%, and 21.3%, respectively. Cardioversion effectively restored rhythm in 52% of the first episode and antitachycardia pacing was sufficient in the remaining. For the whole cohort, ejection fraction (EF) |
| doi_str_mv | 10.1111/pace.12801 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_508551</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1919966294</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5791-a1360cd2e23e4ea4981c93e3eedea8041255c01c219940df0f9d72c5b4e14e093</originalsourceid><addsrcrecordid>eNqFkk1v1DAQhiMEokvhwg9AOaKKFI8_Evu4ypZ-qAUEBU7IcpxZ1myyCXaikn-P290uJ4ovtqxnHo3Hb5K8BHIMcb3tjcVjoJLAo2QGgpNMglCPkxkBXmSSSXWQPAvhJyEkJ1w8TQ5onkeEiFny_ZML6_TK-DX6kJpNnc773ne9d2bA9LztG7MZTNVgusClq7xrGjN0Pr1eoTf9lLpNejb16IdYs3I2LY2vXddOXW-G1fQ8ebI0TcAXu_0w-fLu5Lo8yy4_nJ6X88vMikJBZoDlxNYUKUOOhisJVjFkiDUaSThQISwBS0EpTuolWaq6oFZUHIEjUewwybbecIP9WOnYfmv8pDvj9O5qHU-oBZFCQOTf_JNfuK9z3fkfehw1lTIH-aD-L96OGkBRxSL_esvHSf4aMQy6dcFiHN0GuzFoUPEheU4V_z9aFEQWDO6sR1vU-i4Ej8t9H0D0bRD0bRD0XRAi_GrnHasW6z16__MRgC1w4xqcHlDpj_Py5F66m4MLA_7e18Tw6LxghdDf3p_qi0W5uJCflb5ifwARMs3p</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1770873193</pqid></control><display><type>article</type><title>Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy</title><source>Wiley-Blackwell Journals</source><source>MEDLINE</source><creator>MAGNUSSON, PETER ; GADLER, FREDRIK ; LIV, PER ; MÖRNER, STELLAN</creator><creatorcontrib>MAGNUSSON, PETER ; GADLER, FREDRIK ; LIV, PER ; MÖRNER, STELLAN</creatorcontrib><description>Background
Risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is mainly based on evaluations from patients at highly specialized centers.
Aim
To evaluate risk markers for appropriate implantable cardioverter defibrillator (ICD) therapy in an unselected, nationwide cohort of HCM.
Methods
Patients with an ICD due to HCM were identified from the Swedish ICD Registry since its start in 1995, merged with Patient Register data, and medical records were retrieved. Risk markers for ventricular arrhythmias leading to appropriate ICD therapy were analyzed using Cox proportional hazard ratio (HR).
Results
Of 321 patients (70.1% males), at least one appropriate therapy occurred in 77 (24.0%) during a mean follow‐up of 5.4 years (5.3% per year; primary prevention 4.5%, secondary prevention 7.0%). Cumulative incidences at 1 year, 3 years, and 5 years were 8.1%, 15.3%, and 21.3%, respectively. Cardioversion effectively restored rhythm in 52% of the first episode and antitachycardia pacing was sufficient in the remaining. For the whole cohort, ejection fraction (EF) <50% (HR 2.63; P < 0.001) was associated with appropriate ICD therapy. In primary prevention, patients with established risk markers experienced appropriate therapy; atrial fibrillation (AF; HR 2.54; P = 0.010), EF < 50% (HR 2.78; P = 0.004), and nonsustained ventricular tachycardia (HR 1.80; P = 0.109) had the highest HR, and wall thickness ≥30 mm, syncope, exercise blood pressure response, or family history of SCD had weaker associations.
Conclusion
ICD therapy successfully terminates ventricular arrhythmias in HCM. In addition to conventional risk markers, a history of AF or EF < 50% may be considered in risk stratification.</description><identifier>ISSN: 0147-8389</identifier><identifier>ISSN: 1540-8159</identifier><identifier>EISSN: 1540-8159</identifier><identifier>DOI: 10.1111/pace.12801</identifier><identifier>PMID: 26681505</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Cardiomyopathy, Hypertrophic - mortality ; Cardiomyopathy, Hypertrophic - therapy ; Causality ; Comorbidity ; Death, Sudden, Cardiac - epidemiology ; Death, Sudden, Cardiac - prevention & control ; Defibrillators, Implantable - utilization ; epidemiology ; Female ; Humans ; hypertrophic cardiomyopathy ; implantable cardioverter defibrillator ; Male ; Middle Aged ; Prevalence ; Prognosis ; Registries ; Risk Factors ; risk stratification ; sudden death ; Survival Rate ; Sweden - epidemiology ; Tachycardia, Ventricular - mortality ; Tachycardia, Ventricular - prevention & control ; Treatment Outcome</subject><ispartof>Pacing and clinical electrophysiology, 2016-03, Vol.39 (3), p.291-301</ispartof><rights>2015 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5791-a1360cd2e23e4ea4981c93e3eedea8041255c01c219940df0f9d72c5b4e14e093</citedby><cites>FETCH-LOGICAL-c5791-a1360cd2e23e4ea4981c93e3eedea8041255c01c219940df0f9d72c5b4e14e093</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpace.12801$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpace.12801$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26681505$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-119293$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-288618$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:133218567$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>MAGNUSSON, PETER</creatorcontrib><creatorcontrib>GADLER, FREDRIK</creatorcontrib><creatorcontrib>LIV, PER</creatorcontrib><creatorcontrib>MÖRNER, STELLAN</creatorcontrib><title>Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy</title><title>Pacing and clinical electrophysiology</title><addtitle>Pacing and Clinical Electrophysiology</addtitle><description>Background
Risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is mainly based on evaluations from patients at highly specialized centers.
Aim
To evaluate risk markers for appropriate implantable cardioverter defibrillator (ICD) therapy in an unselected, nationwide cohort of HCM.
Methods
Patients with an ICD due to HCM were identified from the Swedish ICD Registry since its start in 1995, merged with Patient Register data, and medical records were retrieved. Risk markers for ventricular arrhythmias leading to appropriate ICD therapy were analyzed using Cox proportional hazard ratio (HR).
Results
Of 321 patients (70.1% males), at least one appropriate therapy occurred in 77 (24.0%) during a mean follow‐up of 5.4 years (5.3% per year; primary prevention 4.5%, secondary prevention 7.0%). Cumulative incidences at 1 year, 3 years, and 5 years were 8.1%, 15.3%, and 21.3%, respectively. Cardioversion effectively restored rhythm in 52% of the first episode and antitachycardia pacing was sufficient in the remaining. For the whole cohort, ejection fraction (EF) <50% (HR 2.63; P < 0.001) was associated with appropriate ICD therapy. In primary prevention, patients with established risk markers experienced appropriate therapy; atrial fibrillation (AF; HR 2.54; P = 0.010), EF < 50% (HR 2.78; P = 0.004), and nonsustained ventricular tachycardia (HR 1.80; P = 0.109) had the highest HR, and wall thickness ≥30 mm, syncope, exercise blood pressure response, or family history of SCD had weaker associations.
Conclusion
ICD therapy successfully terminates ventricular arrhythmias in HCM. In addition to conventional risk markers, a history of AF or EF < 50% may be considered in risk stratification.</description><subject>Cardiomyopathy, Hypertrophic - mortality</subject><subject>Cardiomyopathy, Hypertrophic - therapy</subject><subject>Causality</subject><subject>Comorbidity</subject><subject>Death, Sudden, Cardiac - epidemiology</subject><subject>Death, Sudden, Cardiac - prevention & control</subject><subject>Defibrillators, Implantable - utilization</subject><subject>epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>hypertrophic cardiomyopathy</subject><subject>implantable cardioverter defibrillator</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prevalence</subject><subject>Prognosis</subject><subject>Registries</subject><subject>Risk Factors</subject><subject>risk stratification</subject><subject>sudden death</subject><subject>Survival Rate</subject><subject>Sweden - epidemiology</subject><subject>Tachycardia, Ventricular - mortality</subject><subject>Tachycardia, Ventricular - prevention & control</subject><subject>Treatment Outcome</subject><issn>0147-8389</issn><issn>1540-8159</issn><issn>1540-8159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkk1v1DAQhiMEokvhwg9AOaKKFI8_Evu4ypZ-qAUEBU7IcpxZ1myyCXaikn-P290uJ4ovtqxnHo3Hb5K8BHIMcb3tjcVjoJLAo2QGgpNMglCPkxkBXmSSSXWQPAvhJyEkJ1w8TQ5onkeEiFny_ZML6_TK-DX6kJpNnc773ne9d2bA9LztG7MZTNVgusClq7xrGjN0Pr1eoTf9lLpNejb16IdYs3I2LY2vXddOXW-G1fQ8ebI0TcAXu_0w-fLu5Lo8yy4_nJ6X88vMikJBZoDlxNYUKUOOhisJVjFkiDUaSThQISwBS0EpTuolWaq6oFZUHIEjUewwybbecIP9WOnYfmv8pDvj9O5qHU-oBZFCQOTf_JNfuK9z3fkfehw1lTIH-aD-L96OGkBRxSL_esvHSf4aMQy6dcFiHN0GuzFoUPEheU4V_z9aFEQWDO6sR1vU-i4Ej8t9H0D0bRD0bRD0XRAi_GrnHasW6z16__MRgC1w4xqcHlDpj_Py5F66m4MLA_7e18Tw6LxghdDf3p_qi0W5uJCflb5ifwARMs3p</recordid><startdate>201603</startdate><enddate>201603</enddate><creator>MAGNUSSON, PETER</creator><creator>GADLER, FREDRIK</creator><creator>LIV, PER</creator><creator>MÖRNER, STELLAN</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D93</scope><scope>DF2</scope></search><sort><creationdate>201603</creationdate><title>Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy</title><author>MAGNUSSON, PETER ; GADLER, FREDRIK ; LIV, PER ; MÖRNER, STELLAN</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5791-a1360cd2e23e4ea4981c93e3eedea8041255c01c219940df0f9d72c5b4e14e093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Cardiomyopathy, Hypertrophic - mortality</topic><topic>Cardiomyopathy, Hypertrophic - therapy</topic><topic>Causality</topic><topic>Comorbidity</topic><topic>Death, Sudden, Cardiac - epidemiology</topic><topic>Death, Sudden, Cardiac - prevention & control</topic><topic>Defibrillators, Implantable - utilization</topic><topic>epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>hypertrophic cardiomyopathy</topic><topic>implantable cardioverter defibrillator</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prevalence</topic><topic>Prognosis</topic><topic>Registries</topic><topic>Risk Factors</topic><topic>risk stratification</topic><topic>sudden death</topic><topic>Survival Rate</topic><topic>Sweden - epidemiology</topic><topic>Tachycardia, Ventricular - mortality</topic><topic>Tachycardia, Ventricular - prevention & control</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MAGNUSSON, PETER</creatorcontrib><creatorcontrib>GADLER, FREDRIK</creatorcontrib><creatorcontrib>LIV, PER</creatorcontrib><creatorcontrib>MÖRNER, STELLAN</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Umeå universitet</collection><collection>SWEPUB Uppsala universitet</collection><jtitle>Pacing and clinical electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MAGNUSSON, PETER</au><au>GADLER, FREDRIK</au><au>LIV, PER</au><au>MÖRNER, STELLAN</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy</atitle><jtitle>Pacing and clinical electrophysiology</jtitle><addtitle>Pacing and Clinical Electrophysiology</addtitle><date>2016-03</date><risdate>2016</risdate><volume>39</volume><issue>3</issue><spage>291</spage><epage>301</epage><pages>291-301</pages><issn>0147-8389</issn><issn>1540-8159</issn><eissn>1540-8159</eissn><abstract>Background
Risk stratification of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is mainly based on evaluations from patients at highly specialized centers.
Aim
To evaluate risk markers for appropriate implantable cardioverter defibrillator (ICD) therapy in an unselected, nationwide cohort of HCM.
Methods
Patients with an ICD due to HCM were identified from the Swedish ICD Registry since its start in 1995, merged with Patient Register data, and medical records were retrieved. Risk markers for ventricular arrhythmias leading to appropriate ICD therapy were analyzed using Cox proportional hazard ratio (HR).
Results
Of 321 patients (70.1% males), at least one appropriate therapy occurred in 77 (24.0%) during a mean follow‐up of 5.4 years (5.3% per year; primary prevention 4.5%, secondary prevention 7.0%). Cumulative incidences at 1 year, 3 years, and 5 years were 8.1%, 15.3%, and 21.3%, respectively. Cardioversion effectively restored rhythm in 52% of the first episode and antitachycardia pacing was sufficient in the remaining. For the whole cohort, ejection fraction (EF) <50% (HR 2.63; P < 0.001) was associated with appropriate ICD therapy. In primary prevention, patients with established risk markers experienced appropriate therapy; atrial fibrillation (AF; HR 2.54; P = 0.010), EF < 50% (HR 2.78; P = 0.004), and nonsustained ventricular tachycardia (HR 1.80; P = 0.109) had the highest HR, and wall thickness ≥30 mm, syncope, exercise blood pressure response, or family history of SCD had weaker associations.
Conclusion
ICD therapy successfully terminates ventricular arrhythmias in HCM. In addition to conventional risk markers, a history of AF or EF < 50% may be considered in risk stratification.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>26681505</pmid><doi>10.1111/pace.12801</doi><tpages>11</tpages></addata></record> |
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| ispartof | Pacing and clinical electrophysiology, 2016-03, Vol.39 (3), p.291-301 |
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| source | Wiley-Blackwell Journals; MEDLINE |
| subjects | Cardiomyopathy, Hypertrophic - mortality Cardiomyopathy, Hypertrophic - therapy Causality Comorbidity Death, Sudden, Cardiac - epidemiology Death, Sudden, Cardiac - prevention & control Defibrillators, Implantable - utilization epidemiology Female Humans hypertrophic cardiomyopathy implantable cardioverter defibrillator Male Middle Aged Prevalence Prognosis Registries Risk Factors risk stratification sudden death Survival Rate Sweden - epidemiology Tachycardia, Ventricular - mortality Tachycardia, Ventricular - prevention & control Treatment Outcome |
| title | Risk Markers and Appropriate Implantable Defibrillator Therapy in Hypertrophic Cardiomyopathy |
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