Predictors of Ventricular Tachyarrhythmias in Patients with Dilated Cardiomyopathy

Purpose of this study is to investigate the markers of myocardial electric instability: microvolt T-wave alternations (mTWA), heart rate turbulence (HRT) and QTdispersion in patients with dilated cardiomyopathy (DCM) with ventricular tachyarrhythmic (VTA) events.

Methods: the study enrolled and followed up 38,1 ±12,6 months 160 pts with DCM (78% male, aged 47,2 ± 11,7 years, LVEF 28,7 ± 10,1%; NYHA class 3,0±0,3). We analyzed age, gender, NYHA, 6-MWT, peak VO2, EchoCG, Holter ECG (PVEct, VT, nsVT, VF), device telemonitoring and ECG (Intecard-7) assessment HRT, mTWA, QT. For multivariate regression model as the primary endpoint had been taken VTA (nsVT\sVT without syncope) and the secondary end points were SCD, successful resuscitation, sVTwith syncope, discharges of CRT-D\ICD.

Results: By multivariate regression analysis for primary end point (F=7,1; R²=0,99; p=0,000) as independent predictors of VTA are defined: PVEct (p=0.00004) LV SD (p=0.0003), QRS width (p=0.0006), LV EDV (p=0.002), 6-MWT (p=0.002) and LBBB (p=0.01). For secondary end points by multivariate analysis (F=5,7; R²=0,77; p=0.0022) were revealed independent predictors of fatal VTA\SCD as test mTWA (р=0.0033) and HRTS (p=0.043).

Conclusions: Positive mTWA and pathological HRTS were identified as independent predictors of life-threatening VTA\SCD. The use of these markers for screening stratification of DCM pts allows to select of potential candidates for preventive ICD therapy.

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