Predictors of high-grade ventricular arrhythmias in patients referred for the coronary angiography

Abstract

Ventricular arrhythmias (VA) are still the leading cause of sudden cardiac death (SCD). Therefore identification of predictors of high-grade (hg) VA and stratification of risk of fatal events remain important problems of cardiology. We analyzed data of 993 patients with and without hgVA according to 24 hours Holter monitoring referred for the coronary angiography. Patients with hgVA were older (57.2 ± 8.4 vs. 54.9 ± 8.3 years, p = 0.001), had lower left ventricular ejection fraction (LVEF) (51.6 ± 11.2 vs. 58.4 ± 7.6%, p < 0.001) and larger extent of LV wall motion abnormalities (10.8 ± 15.7% vs. 5.5 ± 10.9%, p = 0.001). Patients with hgVA more often had LV aneurysms and thrombi. These patients also had significantly greater LV end diastolic diameter (54.3 ± 7.4 vs. 49.9 ± 4.7 mm, p < 0.001), and more often had NYHA class III-IV chronic heart failure (28.1 vs. 15.5%, p < 0.001). According to multivariate analysis hgVA were independently associated with age, LV dilation and reduced LVEF (specificity and sensitivity of a mathematical model for prediction of hgVA were 78 and 49.5%, respectively). Each subsequent year of life increased risk of having hgVA by 1.2% (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.01-1.05, p = 0.002), while 1 mm increase of LV size elevated risk of VA by 4.2% (OR 1.08; 95% CI 1.04-1.13, p < 0.001), and 1% lowering of LVEF increased risk of VA by 7% (OR 0.95; 95% CI 0.92-0.98, p < 0.001).