title: Predictors of serious arrhythmic events in patients with nonischemic heart failure.
abstract: OBJECTIVE
  Risk stratification of serious arrhythmic events in patients with nonischemic heart failure (HF), beyond estimates of left ventricular ejection fraction (LVEF), remains an important clinical challenge. This study aims to determine the clinical value of different noninvasive and invasive tests as predictors of serious arrhythmic events in patients with nonischemic HF.
  
  
  METHODS
  A prospective observational study was conducted including 106 nonischemic HF patients who underwent a comprehensive clinical and laboratory evaluation including two-dimensional echocardiography, 24-h Holter monitoring, cardiopulmonary exercise testing (CPX), and an invasive electrophysiological study. The study's primary end-point was either syncope, appropriate therapy by implantable cardioverter-defibrillators, or sudden cardiac death.
  
  
  RESULTS
  During a mean follow-up of 704 ± 320 days, the primary end-point occurred in 15 patients (14.2%). In multivariable analysis, LV end-diastolic diameter >73 mm (hazard ratio [HR] 3.7; p = 0.016), exercise periodic breathing (EPB) on CPX (HR 2.88; p = 0.045), and non-sustained ventricular tachycardia (NSVT) ≥10 beats (HR 8.2; p < 0.01) remained independently associated with serious arrhythmic events. The positive predictive value of the presence of two of these predictors ranged from 44 to 100%. The absence of all three factors (n = 65, 61% of the sample) identified a subset of patients with low risk of future arrhythmic events, with a negative predictive value of 96.9%.
  
  
  CONCLUSIONS
  In this cohort study of nonischemic HF patients, LV dimension, EPB, and NSVT ≥10 beats were independent predictors of serious arrhythmic events. The presence or absence of these characteristics identified sub-groups of high and low risk of serious arrhythmic events, respectively.
authors.affiliation: Cardiac Electrophysiology Group, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pimentel
authors.affiliation: Heart Failure and Transplant Group, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Zimerman
authors.affiliation: Cardiac Electrophysiology Group, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Diego
authors.initials: D
authors.lastname: Chemello
authors.affiliation: Heart Failure and Transplant Group, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Giaretta
authors.affiliation: Cardiovascular Research Laboratory, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Michael
authors.initials: M
authors.lastname: Andrades
authors.affiliation: Cardiovascular Research Laboratory, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Daiane
authors.initials: D
authors.lastname: Silvello
authors.affiliation: Cardiac Electrophysiology Group, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Leandro
authors.initials: L
authors.lastname: Zimerman
authors.affiliation: Heart Failure and Transplant Group, Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. rohde.le@gmail.com.|Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. rohde.le@gmail.com.|Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, 2nd floor, Porto Alegre, Brazil. rohde.le@gmail.com.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Rohde
mesh_terms: D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000401:mortality*; D001938:Brazil / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality*; D006334:Heart Function Tests / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate
keywords: Arrhythmia; Heart failure; Risk stratification; Sudden cardiac death