title: [Noninvasive Electrophysiological Predictors and Biomarkers of Malignant Arrhythmias in Patients With Ischemic Heart Disease: a 2-Year Prospective Follow-Up].
abstract: OBJECTIVE
  to assess prognostic value of clinical and instrumental parameters, results of noninvasive electrophysiological tests and biomarkers as predictors of malignant ventricular arrhythmias in patients with ischemic heart disease (IHD) during long-term follow-up as well as during myocardial revascularization surgery and early postoperative period.
  
  
  METHODS
  We prospectively enrolled 97 patients (mean age 61+/-10years) with angiographically confirmed coronary artery disease. Most patients (68%) had heart failure NYHA functional class II-III. Mean left ventricular ejection fraction (LVEF) was 50+/-13%; 20% of patients had LVEF less or equal 35%. Sixty two patients had revascularization procedures during follow-up.
  
  
  METHODS
  We used 24-hour Holter monitoring and signal-averaged electrocardiography to obtain the following parameters: microvolt T-wave alternans, QT-interval duration and dynamics, heart rate turbulence (HRT) and variability. Laboratory tests included serum creatinine and creatinine clearance, brain natriuretic peptide (BNP), NT-proBNP, C-reactive protein and troponin T levels.
  
  
  RESULTS
  During mean follow-up period of 25+/-11 months life-threatening ventricular arrhythmias were observed in 11 patients (11%). On univariate analysis, history of percutaneous coronary intervention (p<0.05), history of malignant arrhythmias or syncope (p<0.05), LVEF less or equal 47% (p<0.01), left atrium size more or equal 4.7cm (p<0.05), left atrium index (p=0.01), filtered QRS duration (p<0.05), abnormal heart rate turbulence (HRT) (chi-square test=6.2, p=0.01), abnormal turbulence slope (chi-square test=9.5, p<0.01), BNP more or equal 158picogram/ml (p<0.01), NT-proBNP more or equal 787 rg/ml (chi-square test=4.4, p<0.05) were significantly associated with malignant arrhythmias in long-term follow-up. History of malignant arrhythmias or syncope (OR 11.1, 95% CI 2.8-44.4; p<0.01), abnormal HRT (R 13.6, 95% CI 2.8-66.1; p<0.01), and plasma BNP more or equal 158 picogram/ml (R 14.3, 95% CI 3.2-65.0; p<0.01) were independent predictors of malignant arrhythmias on multivariate Cox regression analysis.
  
  
  CONCLUSIONS
  History of malignant arrhythmias, pathological HRT and plasma brain natriuretic peptide level more or equal 158 picogram/ml were independent predictors of malignant ventricular arrhythmias during 2 years follow-up of patients with ID.
authors.affiliation: A.N. Bakulev Research Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: E Z
authors.initials: EZ
authors.lastname: Golukhova
authors.affiliation: A.N. Bakulev Research Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: O I
authors.initials: OI
authors.lastname: Gromova
authors.affiliation: A.N. Bakulev Research Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: V Yu
authors.initials: VY
authors.lastname: Merzlyakov
authors.affiliation: A.N. Bakulev Research Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: K V
authors.initials: KV
authors.lastname: Shumkov
authors.affiliation: A.N. Bakulev Research Center for Cardiovascular Surgery, Moscow, Russia.
authors.forename: L A
authors.initials: LA
authors.lastname: Bockeria