Electrocardiogram and diabetes mellitus as predictors of mortality benefit from ICD therapy in primary prophylactic patients.

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Lecture Hall 10, Oulu University Hospital. Remote access: https://oulu.zoom.us/j/66489157772?pwd=V1dSNEFUMUMzRGtyTWExcUh4cE5PQT09

Topic of the dissertation

Electrocardiogram and diabetes mellitus as predictors of mortality benefit from ICD therapy in primary prophylactic patients.

Doctoral candidate

Licentiate of Medicine Ari Pelli

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu

Subject of study

Medicine

Opponent

Professor Juha Hartikainen, Kuopio University Hospital, University of Eastern Finland

Custos

Professor Juhani Junttila, Oulu University Hospital, University of Oulu

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Patients who benefit from primary prophylactic ICD therapy should be identified more accurately.

For almost two decades, implantable cardioverter-defibrillator (ICD) has been used for primary prevention to reduce the risk of sudden cardiac death. Primary prophylactic ICD implantation is used in patients with ischemic and non-ischemic cardiomyopathy and impaired left ventricular ejection fraction (≤ 35%). Current guidelines are mainly based on studies published at the beginning of the millennium. The need for better identification of patients who truly benefit from ICD implantation is obvious.

The aim of this thesis was to assess the role of diabetes mellitus and different electrocardiographic variables in predicting the mortality benefit from primary prophylactic ICD implantation. The study population included more than 5,700 patients and 3,864 electrocardiograms (ECG) of the EU-CERT- multicenter study.

In study I, we evaluated the role of diabetes mellitus primary prophylactic ICD patients. We found that diabetes associated with lower risk for appropriate ICD shock, and patients with diabetes had significantly higher all-cause mortality. The results suggest limited benefit from primary prophylactic ICD among patients with diabetes.

In study II, we constructed a low-risk ECG combination. In a retrospective cohort of 1,687 primary prophylactic ICD patients, low-risk ECG predicted survival without appropriate shock. Based on the results, patients with low-risk EGC prior to the ICD implantation may not have significant benefit from the device.

In study III, single traditional and novel ECG variables were coded and investigated in a prospective cohort of 1,477 patients with primary prophylactic ICD and 700 control patients with conventional treatment. Pathological Q waves were a significant predictor of ICD benefit on mortality.

Overall, the findings provide increasing understanding of different benefits from primary prophylactic ICD in patient subgroups. Some patients may have substantially limited mortality benefit from the device, and the indications for ICD implantation require re-assessment.
Last updated: 1.11.2021