© 2008 European Society of Cardiology
Non-sustained ventricular tachycardia as a predictor of sudden cardiac death in patients with left ventricular dysfunction: A meta-analysis
a Post-Graduate Program in Internal Medicine, Universidade Federal de Minas Gerais Brazil
b Cardiology Service, Hospital das Clinicas, Universidade Federal de Minas Gerais Brazil
c Department of Medicine; Arrhythmia Service, Cardiology Division McMaster University — Population Health Research Institute Canada
d School of Medicine, Universidade Federal de Minas Gerais Brazil
* Corresponding author. Cardiology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Rua Aristides Duarte, 39/601 Bairro Prado, ZIP CODE 30.410-040, Belo Horizonte, Minas Gerais, Brazil. Tel.: +55 31 32753624; fax: +55 31 32879213. E-mail address: sousa.mr{at}uol.com.br (M.R. de Sousa).
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Abstract |
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Background: Identifying patients at risk of sudden cardiac death (SCD) remains a challenge.
Aim: To evaluate the performance of non-sustained ventricular tachycardia (NSVT) from 24 hour ambulatory electrocardiography as a predictor of SCD in patients with heart failure or non-ischaemic dilated cardiomyopathy with left ventricular systolic dysfunction (LVSD).
Methods and results: Study search and selection were performed by independent reviewers using a validated strategy. Eleven prognostic studies with > 100 patients with good quality data and multivariate analysis of predictors of SCD were included. Publication bias was evaluated by funnel plot with Kendall's tau b test. A summary ROC (sROC) curve was built to evaluate predictive performance of NSVT. There was threshold effect (Spearman's correlation between sensitivity and specificity=–0.818, p<0.01) which indicates that combining sensitivity and specificity was not appropriate. The area of 0.68±0.02 under the sROC curve indicates a statistically significant contribution of NSVT in the prediction of SCD. The true negative rate varied from 89 to 97%. Multivariate analysis and meta-regression suggested that the contribution of NSVT to risk stratification is independent of ejection fraction.
Conclusions: Absence of NSVT indicated a low probability of SCD in patients with LVSD. A risk score including NSVT should be evaluated in prospective studies.
Key Words: Death, sudden, cardiac • Ventricular dysfunction • Tachycardia, ventricular • Prognosis • Heart failure
Received May 12, 2008; Accepted July 1, 2008
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