Heart failure: nonsustained ventricular tachycardia increased the risk of death.

Clinical bottom line (level 1b)

  1. A third of patients with severe heart failure died within 13 months.
  2. Patients with heart failure were at increased risk of dying within 13 months if they had nonsustained ventricular tachycardia.
  3. A sixth of patients with severe heart failure died suddenly within 13 months.
  4. Patients with heart failure were at increased risk from dying suddenly within 13 months if they had nonsustained ventricular tachycardia.
Doval et al: Circulation 1996; 94: 3198-3203
Expires October 2003

The study

Prospective cohort study with objective outcomes, ?adjusted for confounding factors, not validated in an independent set of patients.

Setting: multicentre, Argentina

516 patients (aged mean 59 years, ?% male) severe heart failure and marked left ventricular systolic dysfunction, with at least 2 of the following: (1) chest radiograph cardiothoracic ratio of >0.55; (2) radionuclide ejection fraction of

Excluded if
  • heart failure not adequately treated with a low-sodium diet, diuretics, digitalis and ACE inhibitors
  • treatment with amiodarone during the 3 months before randomisation
  • thyroid dysfunction
  • severe respiratory failure
  • concomitant serious associated clinical diseases
  • severe valvular heart disease (ie. mitral stenosis, aortic stenosis)and/ or hypertrophic or restrictive cardiomyopathy
  • angina pectoris, myocardial infarction, onset of heart failure or history of syncope within the last 3 months
  • atrioventricular conduction disorder, history of sustained ventricular fibrillation or ventricular fibrillation
  • asymptomatic ventricular tachycardia for >10 beats with an RR interval of <600 msec (rate of >100 min)



    • Factors studied:
  • total mortality
  • nonsustained ventricular tachycardia
  • nonsustained ventricular tachycardia




    • The Cox regression model was used to adjust for confounding factors.

    96% followed for mean 13 months; range 2 to 24 months
    Outcomes studied:
  • total mortality
  • sudden death death within 1 hour of presentation of new symptoms

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    total mortality mean 13 months; range 2 to 24 months 193/516 37.4%
    (33.2% to 41.6%)
    sudden death mean 13 months; range 2 to 24 months 71/516 13.8%
    (10.8% to 16.7%)

    prognostic factor for
    total mortality     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    nonsustained ventricular tachycardia mean 13 months; range 2 to 24 months 1.62
    (1.22 to 2.16)     		5
    (3 to 15)

    prognostic factor for
    sudden death     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    nonsustained ventricular tachycardia mean 13 months; range 2 to 24 months 2.56
    (1.60 to 4.10)     		2
    (1 to 6)

    Citation

    1. Doval HC, Nul DR, Grancelli HO, et al: Nonsustained ventricular tachycardia in severe heart failure: Independent marker of increased mortality due to sudden death. Circulation 1996; 94: 3198-3203
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient severe heart failure
    Intervention or Exposure presence of nonsustained ventricular tachycardia
    Comparison absence of nonsustained ventricular tachycardia
    Outcome mortality