Incidence of malignant ventricular arrhythmias during hospitalization in elderly heart failure patients with reduced ejection fraction and its impact on the prognosis
Objective To analyze the occurrence of malignant ventricular arrhythmias(VA)in elderly heart failure patients with reduced ejection fraction(HFrEF)and its influence on the prognosis.Methods A total of 1 171 elderly patients with heart failure were included in this study.These patients were admitted to the First People's Hospital of Shangqiu from January 2017 to June 2020.They were divided into three groups:VA group(85 cases),HFrEF group(340 cases),and heart failure with normal left ventricular ejection fracture(LVEF)group(340 cases).The division was based on the propensity score matching(PSM)method with a 1∶4∶4 ratio.The main outcome measure was major adverse cardiovascular events(MACE)in the three groups,which were followed up for 2 years.Results After PSM,the N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end diastolic diameter(LVEDD),and left ventricular end systolic diameter(LVESD)of the LVEF normal group were significantly lower than those of the HFrEF group and VA group,while LVEF was significantly higher(P＜0.05 for all).During a median follow-up of 22(17-25)months,a total of 219 cases(28.6％)of MACE occurred,including 30 cardiac deaths,133 readmissions with worsening heart failure,and 56 cases of acute coronary syndrome.Kaplan-Meier survival analysis revealed that the VA group had a significantly higher overall risk of MACE compared to the normal LVEF control group and LVEF reduced control group(x2=6.213,P=0.012).Among the three groups,the VA group exhibited the highest risk of cardiogenic death and worsening heart failure readmission,surpassing the normal LVEF group and HFrEF group(x2=4.143,16.861,both P＜0.05).The results of the multivariate Logistic regression analysis revealed that a history of VA(OR=1.317,95％CI:1.109-1.564,P=0.002),NT-proBNP(OR=2.138,95％CI:1.235-3.701,P=0.007),and LVEDD(OR=2.413,95％CI:1.134-5.135,P=0.022)were found to be associated with an increased risk of VA during hospitalization.Additionally,the multivariate Cox regression analysis indicated that age＞68 years(HR=1.723,95％CI:1.134-2.618,P=0.011),new VA occurrence(HR=2.346,95％CI:1.268-4.341,P=0.007),diabetes(HR=2.008,95％CI.1.135-3.553,P=0.017),NT-proBNP＞1 957.3 ng/L(HR=2.734,95％CI:1.368-5.464,P=0.004),LVEF＜35.0％(HR=2.265,95％CI:1.206-4.254,P=0.011),implantable cardioverter defibrillators(HR=0.887,95％CI:0.789-0.997,P=0.045),and sodium glucose co transporter 2(SGLT2)inhibitors usage(HR=0.904,95％CI:0.833-0.981,P=0.016)were identified as factors related to MACE.Conclusions Patients diagnosed with VA have a significantly increased risk of MACE during the follow-up period.Several factors,including age,new VA occurrence,diabetes,NT-proBNP levels,LVEF,implantable cardioverter defibrillators,and SGLT2 inhibitor usage,have been found to be associated with the risk of MACE during the follow-up.
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