LETTERS TO THE EDITOR
Reply
Laurent Fauchier, MDa
a Service de Cardiologie B, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France
lfau{at}med.univ-tours.fr
In response to the letter by Eryonucu et al., we considered with great interest the report by Szabo et al. (1). We are in absolute disagreement with Eryonucu about the prognostic value demonstrated in this study for the specific end point of sudden death (1). In this brief report, it was clearly stated that a low left ventricular ejection fraction was the only predictor of sudden death in this series of patients with congestive heart failure due to ischemic or idiopathic dilated cardiomyopathy, with a follow-up time half of that in our study (2). A decrease in heart rate variability was not a predictor of sudden death nor was it included in the univariate or multivariate analysis (Table 2). Moreover, we took into account the occurrence of major arrhythmic events (sustained ventricular tachycardia or ventricular fibrillation), whereas these events were not considered by Szabo et al. In view of the several mechanisms of sudden death in congestive heart failure, we consider that the mixed end point of "sudden death or major arrhythmic events" is probably the most specific one if there is a mechanism of ventricular tachyarrhythmia that may be adequately treated by an implantable cardioverter-defibrillator. Clearly, the results of our study may be more helpful for the rationale of future prophylactic studies about implantable cardioverter-defibrillator placement in the particular situation of idiopathic dilated cardiomyopathy.
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References
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- Szabo BM, van Veldhuisen DJ, van der Veer N, Brouwer J, De Graeff PA, Crijns HJGM. Prognostic value of heart rate variability in chronic congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol. 1997;79:978–980[CrossRef][Medline]
- Fauchier L, Babuty D, Cosnay P, Fauchier JP. Prognostic value of heart rate variability for sudden death and major arrhythmic events in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 1999;33:1203–1207[Abstract/Free Full Text]
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