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

<h4>Background</h4>An action potential duration (APD) restitution curve with a steep slope ≥1 has been associated with increased susceptibility for malignant ventricular arrhythmias. We aimed to evaluate the "restitution hypothesis" and tested ventricular APD restitution slope...

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Autores principales:	Marc Dorenkamp, Andreas J Morguet, Christian Sticherling, Steffen Behrens, Markus Zabel
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f6166cc911204b83ace0f071aba214e4
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spelling	oai:doaj.org-article:f6166cc911204b83ace0f071aba214e42021-11-18T08:00:48ZLong-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.1932-620310.1371/journal.pone.0054768https://doaj.org/article/f6166cc911204b83ace0f071aba214e42013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23349967/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>An action potential duration (APD) restitution curve with a steep slope ≥1 has been associated with increased susceptibility for malignant ventricular arrhythmias. We aimed to evaluate the "restitution hypothesis" and tested ventricular APD restitution slope as well as effective refractory period (ERP)/APD ratio for long-term prognostic value in patients with ischemic (ICM) or dilated cardiomyopathy (DCM).<h4>Methodology/principal findings</h4>Monophasic action potentials were recorded in patients with ICM (n = 32) and DCM (n = 42) undergoing routine programmed ventricular stimulation (PVS). Left ventricular ejection fraction was 32±7% and 28±9%, respectively. APD and ERP were measured at baseline stimulation (S(1)) and upon introduction of one to three extrastimuli (S(2)-S(4)). ERP/APD ratios and the APD restitution curve were calculated and the maximum restitution slope was determined. After a mean follow-up of 6.1±3.0 years, the combined end-point of mortality and and/or implantable cardioverter-defibrillator shock was not predicted by restitution slope or ERP/APD ratios. Comparing S(2) vs. S(3) vs. S(4) extrastimuli for restitution slope (1.5±0.6 vs. 1.4±0.4 vs. 1.3±0.5; p = NS), additional extrastimuli did not lead to a steepening restitution slope. ERP/APD ratio decreased with additional extrastimuli (0.98±0.09 [S(1)] vs. 0.97±0.10 [S(2)] vs. 0.93±0.11 [S(3)]; p = 0.03 S(1) vs. S(3)). Positive PVS was strongly predictive of outcome (p = 0.006).<h4>Conclusions/significance</h4>Neither ventricular APD restitution slope nor ERP/APD ratios predict outcome in patients with ICM or DCM.Marc DorenkampAndreas J MorguetChristian SticherlingSteffen BehrensMarkus ZabelPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 1, p e54768 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Marc Dorenkamp Andreas J Morguet Christian Sticherling Steffen Behrens Markus Zabel Long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.
description	<h4>Background</h4>An action potential duration (APD) restitution curve with a steep slope ≥1 has been associated with increased susceptibility for malignant ventricular arrhythmias. We aimed to evaluate the "restitution hypothesis" and tested ventricular APD restitution slope as well as effective refractory period (ERP)/APD ratio for long-term prognostic value in patients with ischemic (ICM) or dilated cardiomyopathy (DCM).<h4>Methodology/principal findings</h4>Monophasic action potentials were recorded in patients with ICM (n = 32) and DCM (n = 42) undergoing routine programmed ventricular stimulation (PVS). Left ventricular ejection fraction was 32±7% and 28±9%, respectively. APD and ERP were measured at baseline stimulation (S(1)) and upon introduction of one to three extrastimuli (S(2)-S(4)). ERP/APD ratios and the APD restitution curve were calculated and the maximum restitution slope was determined. After a mean follow-up of 6.1±3.0 years, the combined end-point of mortality and and/or implantable cardioverter-defibrillator shock was not predicted by restitution slope or ERP/APD ratios. Comparing S(2) vs. S(3) vs. S(4) extrastimuli for restitution slope (1.5±0.6 vs. 1.4±0.4 vs. 1.3±0.5; p = NS), additional extrastimuli did not lead to a steepening restitution slope. ERP/APD ratio decreased with additional extrastimuli (0.98±0.09 [S(1)] vs. 0.97±0.10 [S(2)] vs. 0.93±0.11 [S(3)]; p = 0.03 S(1) vs. S(3)). Positive PVS was strongly predictive of outcome (p = 0.006).<h4>Conclusions/significance</h4>Neither ventricular APD restitution slope nor ERP/APD ratios predict outcome in patients with ICM or DCM.
format	article
author	Marc Dorenkamp Andreas J Morguet Christian Sticherling Steffen Behrens Markus Zabel
author_facet	Marc Dorenkamp Andreas J Morguet Christian Sticherling Steffen Behrens Markus Zabel
author_sort	Marc Dorenkamp
title	Long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.
title_short	Long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.
title_full	Long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.
title_fullStr	Long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.
title_full_unstemmed	Long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.
title_sort	long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/f6166cc911204b83ace0f071aba214e4
work_keys_str_mv	AT marcdorenkamp longtermprognosticvalueofrestitutionslopeinpatientswithischemicanddilatedcardiomyopathies AT andreasjmorguet longtermprognosticvalueofrestitutionslopeinpatientswithischemicanddilatedcardiomyopathies AT christiansticherling longtermprognosticvalueofrestitutionslopeinpatientswithischemicanddilatedcardiomyopathies AT steffenbehrens longtermprognosticvalueofrestitutionslopeinpatientswithischemicanddilatedcardiomyopathies AT markuszabel longtermprognosticvalueofrestitutionslopeinpatientswithischemicanddilatedcardiomyopathies
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Long-term prognostic value of restitution slope in patients with ischemic and dilated cardiomyopathies.

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