P399Postextrasystolic blood pressure potentiation is associated with appropriate device therapy and mortality in implantable cardioverter defibrillator recipients with a reduced LVEF

Abstract

Background: Postextrasystolic potentiation (PESP) is defined as an increase in contractility that follows an extrasystolic beat (ESB). This phenomenon may be associated with changes in myocardial calcium homeostasis and may increase blood pressure especially in heart failure patients. Recently, it was shown that PESP measured non-invasively as post-extrasystolic blood pressure potentiation was a strong and independent predictor of increased mortality in patients with a reduced left ventricular ejection fraction (LVEF). However, it is unclear if the presence of PESP can be used for enhancement of risk stratification for ventricular arrhythmias. Purpose: the purpose of this study was to evaluate the association of presence of PESP with the occurrence of appropriate implantable cardioverter defibrillator (ICD) therapy and mortality in ICD recipients. Methods: 54 patients (87% men, age 59 ± 12 year, 44% ischemic CMP, 65% primary prevention, LVEF 38.6 ± 14.9%) who received an ICD for primary or secondary prevention were included. Patients underwent one to five 6-minute continuous finger atrial blood pressure measurements with a photoplethysmographic device, during multiple clinical follow-up appointments. Raw blood pressure signals were reviewed to identify ESB. Isolated ESB preceded by at least 8 sinus beats were used for analysis. Patients were marked as PESP positive if all 6-minute recordings showed an averaged systolic pressure increase of the first post-ESB compared to the pre-ESB. All other patients were marked as PESP negative. Results: In 35 (65%) of the 54 patients at least one ESB episode was detected. A total of 13 (24%) patients were marked as PESP positive and 41 (76%) patients as PESP negative. The mean number of follow-up visits was 2.4 ± 1.19. During a followup of 540 ± 357 days, 11 (20%) patients received appropriate ICD therapy and 5 (9%) patients died. The combined end point of appropriate device therapy and mortality occurred in 16 (30%) patients, and was found significantly more in PESP positive patients compared with PESP negative patients (54% versus 22%, p=0.04). PESP positive patients did not receive appropriate device therapy more frequently (p=0.109). However, in patients with a LVEF ≤ 35% (n=21), appropriate device therapy occurred significantly more often in PESP positive patients compared with PESP negative patients (19% versus 0%, p=0.035, respectively). Conclusion: Although the current study is based on a small sample of ICD patients, these findings suggest that PESP is associated with an increase of appropriate ICD therapy and mortality, especially in patients with a reduced LVEF. (Figure Presented).