title: Nonsustained ventricular tachycardia in severe heart failure. Independent marker of increased mortality due to sudden death. GESICA-GEMA Investigators.
abstract: BACKGROUND
  The goal of the study was to determine the prognostic value of nonsustained ventricular tachycardia (NSVT) in total mortality in severe congestive heart failure (CHF) and in death modes. NSVT is associated with an increased mortality in CHF. However, the predictive value of NSVT as a marker for sudden death or death due to progressive heart failure has not been determined.
  
  
  RESULTS
  Five hundred sixteen patients from the GESICA trial (33.4% with NSVT) were initially studied with the results of 24-hour Holter and 2 years of follow-up. Within 2 years, 87 of 173 patients (50.3%) with NSVT and 106 of 343 patients (30.9%) without NSVT died. Relative risk (RR) was 1.69 (95% confidence interval [CI], 1.27 to 2.24; P < .0002), and Cox proportional hazard analysis was 1.62 (95% CI, 1.22 to 2.16; P < .001). Sudden death increased from 8.7% (30 of 343) to 23.7% (41 of 173) in patients with NSVT (RR, 2.77; 95% CI, 1.78 to 4.44; P < .001). Progressive heart failure death was also increased from 17.5% (60 of 343) to 20.8% (36 of 173) (P = .22). Quantitative analysis of 24-hour Holter (first 295 patients) demonstrated that couplets had a similar RR to that of NSVT for both total mortality (RR, 1.81; 95% CI, 1.22 to 2.66; P < .002) and sudden death (RR, 3.37; 95% CI, 1.57 to 7.25; P < .0005). Couplets and/or NSVT (ventricular repetitive beats) were even more predictive for sudden death (RR, 10.1; 95% CI, 1.91 to 52.7; P < .01).
  
  
  CONCLUSIONS
  In patients with CHF, NSVT is an independent marker for increased overall mortality rate and sudden death. The absence of NSVT and ventricular repetitive beats in a 24-hour Holter indicates a low probability of sudden death.
authors.forename: H C
authors.initials: HC
authors.lastname: Doval
authors.forename: D R
authors.initials: DR
authors.lastname: Nul
authors.forename: H O
authors.initials: HO
authors.lastname: Grancelli
authors.forename: S D
authors.initials: SD
authors.lastname: Varini
authors.forename: S
authors.initials: S
authors.lastname: Soifer
authors.forename: G
authors.initials: G
authors.lastname: Corrado
authors.forename: S
authors.initials: S
authors.lastname: Dubner
authors.forename: O
authors.initials: O
authors.lastname: Scapin
authors.forename: S V
authors.initials: SV
authors.lastname: Perrone
mesh_terms: D000638:Amiodarone / Q000627:therapeutic use*; D000704:Analysis of Variance; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016001:Confidence Intervals; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D017180:Tachycardia, Ventricular; D018487:Ventricular Dysfunction, Left
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone