Sudden cardiac death risk stratification in patients with nonischemic dilated cardiomyopathy
Open accessAbstract
Objectives The purpose of this study was to provide a meta-analysis to estimate the performance of 12 commonly reported risk stratification tests as predictors of arrhythmic events in patients with nonischemic dilated cardiomyopathy.Background Multiple techniques have been assessed as predictors of death due to ventricular tachyarrhythmias/sudden death in patients with nonischemic dilated cardiomyopathy.Methods Forty-five studies enrolling 6,088 patients evaluating the association between arrhythmic events and predictive tests (baroreflex sensitivity, heart rate turbulence, heart rate variability, left ventricular end-diastolic dimension, left ventricular ejection fraction, electrophysiology study, nonsustained ventricular tachycardia, left bundle branch block, signal-averaged electrocardiogram, fragmented QRS, QRS-T angle, and T-wave alternans) were included. Raw event rates were extracted, and meta-analysis was performed using mixed effects methodology. We also used the trim-and-fill method to estimate the influence of missing studies on the results.Results Patients were 52.8 ± 14.5 years of age, and 77% were male. Left ventricular ejection fraction was 30.6 ± 11.4%. Test sensitivities ranged from 28.8% to 91.0%, specificities from 36.2% to 87.1%, and odds ratios from 1.5 to 6.7. Odds ratio was highest for fragmented QRS and TWA (odds ratios: 6.73 and 4.66, 95% confidence intervals: 3.85 to 11.76 and 2.55 to 8.53, respectively) and lowest for QRS duration (odds ratio: 1.51, 95% confidence interval: 1.13 to 2.01). None of the autonomic tests (heart rate variability, heart rate turbulence, baroreflex sensitivity) were significant predictors of arrhythmic outcomes. Accounting for publication bias reduced the odds ratios for the various predictors but did not eliminate the predictive association.Conclusions Techniques incorporating functional parameters, depolarization abnormalities, repolarization abnormalities, and arrhythmic markers provide only modest risk stratification for sudden cardiac death in patients with nonischemic dilated cardiomyopathy. It is likely that combinations of tests will be required to optimize risk stratification in this population.
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In NIDCM, the prognostic value of AECG is rather low and remains controversial.
“in contradistinction to what is reported in patients with ischemic cardiomyopathy, the prognostic value of AECG in NIDCM is rather low and remains controversial”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Goldberger et al., 2014
The Discussion says no individual risk-stratification technique is precise enough for clinical decisions in NIDCM, supporting the claim of limited prognostic value. But Table 2 reports that nonsustained ventricular tachycardia is a significant predictor, while heart-rate variability is not; the paper does not establish that AECG as a whole remains controversial or that its prognostic value is lower than in ischemic cardiomyopathy. The indexed passages provide section labels but no page numbers. (LLM, conf=0.81)
Experimental — accuracy not yet measuredThe negative predictive value of NSVT was as high as 90%; however, its positive predictive value was only 20%.
“The negative predictive value of NSVT was as high as 90%; however, its positive predictive value was only 20%.”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Goldberger et al., 2014
A more recent meta-analysis by Goldberger et al. (2014) concluded that NSVT evaluated alone was a significant risk predictor (OR 2.92, p < .001) of an arrhythmic endpoint.
“A more recent meta-analysis by Goldberger et al. (2014) based on 45 studies encompassing over 6,000 patients concluded that NSVT evaluated alone was a significant risk predictor (OR 5 2.92, p , .001) of an arrhythmic endpoint”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Goldberger et al., 2014
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- Authors
- Goldberger, J. J., Subačius, H., Patel, T., Cunnane, R., & Kadish, A. H.
- Affiliations
- Northwestern University (US)
- University of Chicago (US)
- Touro College (US)
- Corresponding author
- Goldberger, Jeffrey J.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 63
- Issue
- 18
- Pages
- 1879-1889
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2030295759
- Cited by
- 237
- References
- 82
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 13 · 2023: 15 · 2022: 21 · 2021: 24 · 2020: 17 · 2019: 20 · 2018: 22 · 2017: 32 · 2016: 24 · 2015: 21 · 2014: 6
- FWCI
- 18.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Touro Scholar (Touro College) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- sudden cardiac death, non-ischemic dilated cardiomyopathy, risk stratification, ventricular arrhythmias, T-wave alternans, fragmented QRS complex, QRS-T angle, left bundle branch block, signal-averaged electrocardiogram, heart rate variability, baroreflex sensitivity, heart rate turbulence, left ventricular ejection fraction, left ventricular end-diastolic diameter
- MeSH terms
- Adult, Aged, Cardiomyopathy, Dilated, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk Factors, Cohort Studies, Death, Sudden, Cardiac
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