Cited by 237Cardiac electrophysiology and arrhythmiasCardiac pacing and defibrillation studiesCardiac Arrhythmias and Treatments

The DOI matches its Crossref record; 82 of the 82 references it cites were found in a registry or an index.

Sudden Cardiac Death Risk Stratification in Patients With Nonischemic Dilated Cardiomyopathy

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Goldberger, Jeffrey J., Subačius, Haris, Patel, Taral, Cunnane, Ryan, Kadish, Alan H.·2014·Journal of the American College of Cardiology

Abstract

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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Metadata

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
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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