Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH, USA.
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Europace. 2024 Jun 3;26(6). doi: 10.1093/europace/euae127.
Ablation of monomorphic ventricular tachycardia (MMVT) has been shown to reduce shock frequency and improve survival. We aimed to compare cause-specific risk factors for MMVT and polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF) and to develop predictive models.
The multicentre retrospective cohort study included 2668 patients (age 63.1 ± 13.0 years; 23% female; 78% white; 43% non-ischaemic cardiomyopathy; left ventricular ejection fraction 28.2 ± 11.1%). Cox models were adjusted for demographic characteristics, heart failure severity and treatment, device programming, and electrocardiogram metrics. Global electrical heterogeneity was measured by spatial QRS-T angle (QRSTa), spatial ventricular gradient elevation (SVGel), azimuth, magnitude (SVGmag), and sum absolute QRST integral (SAIQRST). We compared the out-of-sample performance of the lasso and elastic net for Cox proportional hazards and the Fine-Gray competing risk model. During a median follow-up of 4 years, 359 patients experienced their first sustained MMVT with appropriate implantable cardioverter-defibrillator (ICD) therapy, and 129 patients had their first PVT/VF with appropriate ICD shock. The risk of MMVT was associated with wider QRSTa [hazard ratio (HR) 1.16; 95% confidence interval (CI) 1.01-1.34], larger SVGel (HR 1.17; 95% CI 1.05-1.30), and smaller SVGmag (HR 0.74; 95% CI 0.63-0.86) and SAIQRST (HR 0.84; 95% CI 0.71-0.99). The best-performing 3-year competing risk Fine-Gray model for MMVT [time-dependent area under the receiver operating characteristic curve (ROC(t)AUC) 0.728; 95% CI 0.668-0.788] identified high-risk (> 50%) patients with 75% sensitivity and 65% specificity, and PVT/VF prediction model had ROC(t)AUC 0.915 (95% CI 0.868-0.962), both satisfactory calibration.
We developed and validated models to predict the competing risks of MMVT or PVT/VF that could inform procedural planning and future randomized controlled trials of prophylactic ventricular tachycardia ablation.
URL:www.clinicaltrials.gov Unique identifier:NCT03210883.
消融单形性室性心动过速（MMVT）已被证明可降低电击频率并提高存活率。我们旨在比较 MMVT 与多形性室性心动过速（PVT）/心室颤动（VF）的特定病因危险因素，并建立预测模型。
这项多中心回顾性队列研究纳入了 2668 名患者（年龄 63.1±13.0 岁；23%为女性；78%为白人；43%为非缺血性心肌病；左心室射血分数 28.2±11.1%）。Cox 模型调整了人口统计学特征、心力衰竭严重程度和治疗、器械编程以及心电图指标。通过空间 QRS-T 角（QRSTa）、空间心室梯度抬高（SVGel）、方位、幅度（SVGmag）和绝对 QRST 积分总和（SAIQRST）测量整体电异质性。我们比较了套索和弹性网络在 Cox 比例风险和 Fine-Gray 竞争风险模型中的表现。在中位数为 4 年的随访期间，359 名患者经历了首次适当植入式心律转复除颤器（ICD）治疗的持续性 MMVT，129 名患者经历了首次适当 ICD 电击的 PVT/VF。MMVT 的风险与更宽的 QRSTa[风险比（HR）1.16；95%置信区间（CI）1.01-1.34]、更大的 SVGel（HR 1.17；95%CI 1.05-1.30）和更小的 SVGmag（HR 0.74；95%CI 0.63-0.86）和 SAIQRST（HR 0.84；95%CI 0.71-0.99）相关。用于 MMVT 的最佳 3 年竞争风险 Fine-Gray 模型[时间依赖性受试者工作特征曲线下面积（ROC(t)AUC）0.728；95%CI 0.668-0.788]确定了高风险（>50%）患者，具有 75%的敏感性和 65%的特异性，而 PVT/VF 预测模型的 ROC(t)AUC 为 0.915（95%CI 0.868-0.962），两者均具有良好的校准度。
我们开发并验证了预测 MMVT 或 PVT/VF 竞争风险的模型，可为程序性治疗计划和未来预防性室性心动过速消融的随机对照试验提供信息。
网址：www.clinicaltrials.gov 唯一标识符：NCT03210883。
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