title: Prognostic role of non-sustained ventricular tachycardia in a large cohort of patients with idiopathic dilated cardiomyopathy.
abstract: BACKGROUND
  The identification of patients with idiopathic dilated cardiomyopathy (IDC) at higher risk of sudden death (SD) is still an unsolved issue, and the role of non-sustained ventricular tachycardia (NSVT) uncertain.
  
  
  METHODS
  The effect of NSVT on total mortality, SD and life-threatening arrhythmias was evaluated in 554 patients with IDC on optimal medical treatment and at long-term follow-up (81 +/- 58 months).
  
  
  RESULTS
  At diagnosis, 240 patients (43%) had NSVT at Holter monitoring and 314 (57%) did not. During follow-up, 189 patients (5/100 patients-year) died or underwent heart transplantation; SD occurred in 53 patients (1.4/100 patients-year); SD + non-fatal ventricular arrhythmias occurred in 75 patients (2/100 patients-year). Patients with and without NSVT at diagnosis had the same 5-year transplant-free survival rate (76 vs 76%, p = NS) and a similar incidence of SD (10 vs 7%, p = NS). The length and rate of NSVT did not show any significant relationship with the outcome. Only heart failure symptoms (NYHA class III-IV) (hazard ratio [HR] 1.9, p = 0.015) and severe left ventricular impairment (left ventricular ejection fraction < or = 0.30 and left ventricular end-diastolic diameter > or = 70 mm) (HR 2.7, p < 0.0001) were independently associated with higher SD risk. At multivariate analysis the presence of frequent NSVT episodes (> or = 3 runs/day) was associated with an increased risk of total mortality (HR 1.68, p = 0.041) and of major ventricular arrhythmias (HR 2.11, p = 0.037), but only in the subgroup of patients with severe left ventricular impairment.
  
  
  CONCLUSIONS
  Patients with advanced heart failure symptoms, severe left ventricular dysfunction and dilation had a higher risk of SD independently of NSVT. The finding of more frequent NSVT was associated with an increased risk of all-cause mortality and of major ventricular arrhythmias in patients with severe left ventricular impairment.
authors.affiliation: Cardiology Department, University of Trieste, Trieste, Italy. massimo.zecchin@aliceposta.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Zecchin
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.forename: Michele
authors.initials: M
authors.lastname: Moretti
authors.forename: Mauro
authors.initials: M
authors.lastname: Driussi
authors.forename: Aneta
authors.initials: A
authors.lastname: Aleksova
authors.forename: Dorita
authors.initials: D
authors.lastname: Chersevani
authors.forename: Gastone
authors.initials: G
authors.lastname: Sabbadini
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis