Abstract
Prediction of arrhythmic events (AEs) has gained importance with the availability of implantable cardioverter-defibrillators (ICDs), but is still imprecise. This study evaluated the innovative Wedensky modulation index (WMI) as predictor of AEs. In this prospective cohort, 179 patients with coronary artery disease (CAD) referred for AE risk assessment underwent baseline evaluation including measurement of R-/T-wave WMI (WMI(RT)) and left ventricular ejection fraction (LVEF). Two endpoints were assessed 3 years after the baseline evaluation: sudden cardiac death or appropriate ICD event (EP1) and any cardiac death or appropriate ICD event (EP2). Associations between baseline predictors (WMI(RT) and LVEF) and endpoints were evaluated in regression models. Only three patients were lost to follow-up. EP1 and EP2 occurred in 24 and 27 patients, respectively. WMI(RT) (odds ratio [OR] per 1 point increase for EP1 20.1, 95% confidence interval [CI] 1.8-221.4, p = 0.014, and for EP2 73.3, 95% CI 6.6-817.7, p <0.001) and LVEF (OR per 1% increase for EP1 0.94, 95% CI 0.90-0.99, p = 0.013, and for EP2 0.93, 95% CI 0.89-0.97, p = 0.002) were significantly associated with both endpoints. In bivariable regression controlled for LVEF, WMI(RT) was independently associated with EP1 (p = 0.047) and EP2 (p = 0.007). The combination of WMI(RT) ≥0.60 and LVEF ≤30% resulted in a positive predictive value of 36% for EP1 and 50% for EP2. WMI(RT) is a significant predictor of AEs independent of LVEF and has potential to improve AE risk prediction in CAD patients. However, WMI(RT) should be evaluated in larger and independent samples before recommendations for clinical routine can be made.
Highlights
Implantable cardioverter-defibrillators (ICDs) can prevent arrhythmic events (AEs) causing sudden cardiac death (SCD) [1,2,3]
This study evaluated the innovative Wedensky modulation index (WMI) as predictor of AEs
In bivariable regression controlled for left ventricular ejection fraction (LVEF), WMIRT was independently associated with EP1 (p = 0.047) and EP2 (p = 0.007)
Summary
Implantable cardioverter-defibrillators (ICDs) can prevent arrhythmic events (AEs) causing sudden cardiac death (SCD) [1,2,3]. The currently used criteria for ICD implantation are still far from perfect. Several clinical studies evaluated WMI as a SCD risk predictor and documented its ability to stratify the risk [15,16,17,18]. In these previous studies patients were at the highest risk of SCD (mostly patients who had ICDs), the sample size was small, or there was no follow-up with hard endpoints. This study investigated WMI in an adequately powered sample of patients with coronary artery disease (CAD) as predictor of
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