TY - JOUR
T1 - Relationship of specific coronary lesions and regional left ventricular dysfunction to prognosis in survivors of sudden cardiac death
AU - Vlay, Stephen C.
AU - Reid, Philip R.
AU - Griffith, Lawrence S.C.
AU - Kallman, Clayton H.
N1 - Funding Information:
From the Division of Cardiovascular Medicine, The Johns Hopkins Medical Institutions; and the Division of Cardiology, Department Medicine, The State University of New York at Stony Brook. This work was supported in part by grants from the General Research Center No. RROOO35-21, the Outpatient Clinical Research No. RROO722-9, and Ischemic Heart Disease SCOR P50-HL-171X5-07. Computational assistance was received from CLINFO, sponsored National Institutes of Health Grant No. 5MOlRR35-20. for publication Apr. 2, 1984; accepted May 2, 1984. Reprint requests: Stephen C. Way, M.D., Health Sciences Center T-17, Room 020, SUNY at Stony Brook, Stony Brook, NY 11794.
PY - 1984/11
Y1 - 1984/11
N2 - We prospectively evaluated the relationship of specific coronary arterial and left ventricular segments to subsequent clinical outcome in 80 persons who were survivors of sudden cardiac death and had failed conventional antiarrhythmic therapy. There were 68 men and 12 women with an average age of 51 years who were treated with investigational antiarrhythmic agents, randered asymptomatic, and followed for 16 ± 14 (SD) months. At the end of the study 48 patients (60%) were alive and asymptomatic while 32 (40%) had experienced either recurrent syncope (five) or sudden cardiac death (27). The independent relationship of clinical and angiographic variables was performed in a univariate fashion using a Kaplan-Meier survival analysis and then multivariate logistic analysis was used to simultaneously consider all clinical and arteriographic variables. The results reconfirmed the importance of ejection fraction and left ventricular filling pressure on outcome. However, coronary arterial and left ventricular segmental analyses provided additional predictive power. Specifically, the survival outcome was found to be inversely related to the degree of proximal left anterior coronary (LAD) arterial narrowing: at 1 year 90% of patients with minimal LAD narrowing were alive/asymptomatic in contrast with 70% who had partial and 40% who had complete proximal LAD obstruction (p < 0.005). Analysis of the posterobasal left ventricular segment wall motion demonstrated that 100% of patients with minimal dysfunction were alive/asymptomatic at 1 year, whereas only 52% of patients with severe dysfunction were alive (p < 0.001). A multivariate analysis using both LAD narrowing and posterobasal dysfunction correctly predicted 39 of 43 patients (91%) who were alive and 11 of 15 patients (73%) who were dead/syncopal, for a predictive accuracy of 86%. These results suggest that specific segmental cardiac lesions may accurately identify subsets of sudden cardiac death survivors who are at either exceptionally high or low risk for subsequent arrhythmic events. Application of this approach to patient management may permit improvements in the individual risk-benefit ratio of therapy.
AB - We prospectively evaluated the relationship of specific coronary arterial and left ventricular segments to subsequent clinical outcome in 80 persons who were survivors of sudden cardiac death and had failed conventional antiarrhythmic therapy. There were 68 men and 12 women with an average age of 51 years who were treated with investigational antiarrhythmic agents, randered asymptomatic, and followed for 16 ± 14 (SD) months. At the end of the study 48 patients (60%) were alive and asymptomatic while 32 (40%) had experienced either recurrent syncope (five) or sudden cardiac death (27). The independent relationship of clinical and angiographic variables was performed in a univariate fashion using a Kaplan-Meier survival analysis and then multivariate logistic analysis was used to simultaneously consider all clinical and arteriographic variables. The results reconfirmed the importance of ejection fraction and left ventricular filling pressure on outcome. However, coronary arterial and left ventricular segmental analyses provided additional predictive power. Specifically, the survival outcome was found to be inversely related to the degree of proximal left anterior coronary (LAD) arterial narrowing: at 1 year 90% of patients with minimal LAD narrowing were alive/asymptomatic in contrast with 70% who had partial and 40% who had complete proximal LAD obstruction (p < 0.005). Analysis of the posterobasal left ventricular segment wall motion demonstrated that 100% of patients with minimal dysfunction were alive/asymptomatic at 1 year, whereas only 52% of patients with severe dysfunction were alive (p < 0.001). A multivariate analysis using both LAD narrowing and posterobasal dysfunction correctly predicted 39 of 43 patients (91%) who were alive and 11 of 15 patients (73%) who were dead/syncopal, for a predictive accuracy of 86%. These results suggest that specific segmental cardiac lesions may accurately identify subsets of sudden cardiac death survivors who are at either exceptionally high or low risk for subsequent arrhythmic events. Application of this approach to patient management may permit improvements in the individual risk-benefit ratio of therapy.
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U2 - 10.1016/0002-8703(84)90744-0
DO - 10.1016/0002-8703(84)90744-0
M3 - Article
C2 - 6496279
AN - SCOPUS:0021688483
SN - 0002-8703
VL - 108
SP - 1212
EP - 1220
JO - American heart journal
JF - American heart journal
IS - 5
ER -