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Long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies

Marc Dorenkamp1, Andreas J Morguet, Christian Sticherling

  • 1Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany. marc.dorenkamp@charite.de

Plos One
|January 26, 2013
PubMed

Insights

Neither action potential duration restitution slope nor effective refractory period/APD ratios predict long-term outcomes in cardiomyopathy patients. Programmed ventricular stimulation, however, strongly predicted patient prognosis.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Research

Background:

  • The restitution hypothesis suggests steep action potential duration (APD) restitution slopes predict malignant ventricular arrhythmias.
  • Patients with ischemic (ICM) and dilated cardiomyopathy (DCM) are at risk for such arrhythmias.
  • Evaluating APD restitution slope and effective refractory period (ERP)/APD ratio for prognostic value is crucial.

Purpose of the Study:

  • To test the restitution hypothesis in patients with ICM and DCM.
  • To determine the long-term prognostic value of ventricular APD restitution slope and ERP/APD ratio.
  • To compare these parameters with programmed ventricular stimulation (PVS) for predicting patient outcomes.

Main Methods:

  • Monophasic action potentials were recorded in 74 patients (32 ICM, 42 DCM) during routine PVS.
  • APD and ERP were measured at baseline and with increasing extrastimuli (S2-S4).
  • APD restitution slope and ERP/APD ratios were calculated; long-term outcomes (mortality/ICD shock) were tracked over 6.1 years.

Main Results:

  • Neither APD restitution slope nor ERP/APD ratios predicted the combined endpoint of mortality or ICD shock.
  • Increasing extrastimuli did not significantly steepen the APD restitution slope.
  • ERP/APD ratios decreased with additional extrastimuli (p=0.03 for S1 vs. S3).
  • Positive PVS results were strongly predictive of adverse outcomes (p=0.006).

Conclusions:

  • Ventricular APD restitution slope and ERP/APD ratios do not predict long-term outcomes in patients with ICM or DCM.
  • Programmed ventricular stimulation is a significant predictor of prognosis in these patient groups.
  • The findings challenge the direct prognostic utility of the restitution hypothesis in this population.
Abstract

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