Limitations of Ejection Fraction for Prediction of Sudden Death Risk in Patients With Coronary Artery DiseaseLessons From the MUSTT Study
Alfred E. Buxton, MD, FACC*,*,
Kerry L. Lee, PhD ,
Gail E. Hafley, MS,
Luis A. Pires, MD ,
John D. Fisher, MD ,
Michael R. Gold, MD||,
Mark E. Josephson, MD#,
Michael H. Lehmann, MD**,
Eric N. Prystowsky, MD for the MUSTT Investigators
* Department of Medicine, Cardiology Division, Brown Medical School and Lifespan Academic Medical Center, Providence, Rhode Island
Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
St. John Hospital and Medical Center and Wayne State University School of Medicine, Detroit, Michigan
Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
|| Medical University of South Carolina, Charleston, South Carolina
# Beth Israel Deaconess Medical Center, Boston, Massachusetts
** Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
Care Group, Indianapolis, Indiana
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Figure 1 Derivation of Study Population
Flow diagram depicting patient enrollment in the MUSTT (Multicenter Unsustained Tachycardia Trial) study and derivation of patients for the present study. This figure depicts the evolution of patient enrollment in the MUSTT study, with randomization status. For the present study, only patients that did not receive antiarrhythmic treatment (including pharmacologic and device therapy) and in whom complete data on heart failure status was known were included. EP = electrophysiologic; VT = ventricular tachycardia.
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Figure 2 Relationship of Multivariable Risk Scores to 2-Year Event Rates
Graphical representation of risk stratification algorithm to predict 2-year event rate. Dotted lines surrounding each event curve depict 95% confidence intervals. The table beneath the graph relates numerical risk scores for total mortality (TM) and arrhythmic death or cardiac arrest (AD/CA) to 2-year mortality for each end point.
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Figure 3 Example of a Low-Risk Patient With EF <30%
Graphical representation of the hypothetical patient described in the text as example A. This patient's only risk factors are reduced ejection fraction (EF) and age 60 years. CABG = coronary artery bypass graft; NSVT = nonsustained ventricular tachycardia; other abbreviations as in Figure 1.
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Figure 4 Example of a High-Risk Patient With EF <30%
Graphical representation of the hypothetical patient described in the text as example B. Like the patient described in example A (Fig. 3), this patient is 60 years old with reduced EF. However, this patient has additional risk factors of symptomatic heart failure and left bundle branch block (LBBB). Predicted risk for both total mortality and arrhythmic death is much higher than that of the patient without heart failure symptoms or left bundle branch block. NYHA = New York Heart Association; other abbreviations as in Figures 1 and 3.
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Figure 5 Example of a High-Risk Patient With EF >30%
Graphical representation of the hypothetical patient described in the text as example C. This patient's ejection fraction (EF) is greater than 30%, but because symptomatic heart failure and inducible VT are present, the risks for both total mortality and arrhythmic death are comparable to those of some patients with much lower EF. Abbreviations as in Figures 3 and 4.
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