Characteristics Associated with Ventricular Tachyarrhythmias and Their Prognostic Impact in Heart Failure with Mildly Reduced Ejection Fraction
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Patients, Design, and Data Collection
2.2. Inclusion and Exclusion Criteria
2.3. Risk Stratification
2.4. Study Endpoints
2.5. Statistical Methods
3. Results
3.1. Study Population
3.2. Patient Characteristics Associated with nsVT and sVT/VF in Patients with HFmrEF
3.3. Prognostic Impact of nsVT and sVT/VF
3.4. Multivariable Cox Regression Analyses
3.5. Prognostic Impact of nsVT and sVT/VF in Subgroups with or without AMI during the Index Admission
4. Discussion
4.1. Study Limitations
4.2. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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No Ventricular Arrhythmia (n = 2088) | nsVT (n = 44) | sVT/VF (n = 52) | p-Value across Groups | p-Value None vs. nsVT | p-Value None vs. sVT/VF | p-Value nsVT vs. sVT/VF | ||||
---|---|---|---|---|---|---|---|---|---|---|
Age, median (IQR) | 76 (64–83) | 74 (68–82) | 68 (56–77) | 0.003 | 0.610 | 0.001 | 0.034 * | |||
Male sex, n (%) | 1339 | (64.1) | 31 | (70.5) | 40 | (76.9) | 0.116 | - | - | - |
Body mass index, kg/m2, median (IQR) | 26.6 (23.8–30.7) | 26.5 (24.6–30.8) | 26.7 (24.0–32.2) | 0.771 | - | - | - | |||
SBP, mmHg, median (IQR) | 143 (125–163) | 141 (115–150) | 133 (119–152) | 0.050 | 0.187 | 0.037 * | 0.581 | |||
DBP, mmHg, median (IQR) | 80 (69–90) | 75 (67–89) | 75 (64–87) | 0.368 | - | - | - | |||
Heart rate, bpm, median (IQR) | 80 (68–94) | 84 (70–100) | 82 (71–99) | 0.370 | - | - | - | |||
Medical history, n (%) | ||||||||||
Coronary artery disease | 856 | (41.0) | 20 | (45.5) | 20 | (38.5) | 0.779 | - | - | - |
Prior myocardial infarction | 495 | (23.7) | 9 | (20.5) | 17 | (32.7) | 0.281 | - | - | - |
Prior PCI | 583 | (27.9) | 13 | (29.5) | 16 | (30.8) | 0.880 | - | - | - |
Prior CABG | 202 | (9.7) | 7 | (15.9) | 5 | (9.6) | 0.387 | - | - | - |
Prior valvular surgery | 91 | (4.4) | 3 | (6.8) | 2 | (3.8) | 0.719 | - | - | - |
Congestive heart failure | 705 | (33.8) | 17 | (38.6) | 19 | (36.5) | 0.734 | - | - | - |
Decompensated heart failure < 12 months | 228 | (10.9) | 5 | (11.4) | 5 | (9.6) | 0.952 | - | - | - |
Prior sVT/VF | 53 | (2.5) | 5 | (11.4) | 8 | (15.4) | 0.001 | 0.001 | 0.001 | 0.566 |
Prior ICD | 33 | (1.6) | 2 | (4.5) | 7 | (13.5) | 0.001 | 0.126 | 0.001 | 0.135 |
Prior sICD | 9 | (0.4) | 0 | (0.0) | 0 | (0.0) | 0.812 | - | - | - |
Prior CRT-D | 29 | (1.4) | 1 | (2.3) | 2 | (3.8) | 0.313 | - | - | - |
Indication for (s)ICD/CRT-D | ||||||||||
Primary prevention | 54 | (2.6) | 1 | (2.3) | 4 | (7.7) | 0.001 | 0.033 * | 0.001 | 0.289 |
Secondary prevention | 17 | (0.8) | 2 | (4.5) | 5 | (9.6) | ||||
Prior pacemaker | 193 | (9.2) | 4 | (9.1) | 3 | (5.8) | 0.692 | - | - | - |
Chronic kidney disease | 658 | (31.5) | 11 | (25.0) | 10 | (19.2) | 0.114 | - | - | - |
Peripheral artery disease | 239 | (11.4) | 6 | (13.6) | 8 | (15.4) | 0.621 | - | - | - |
Stroke | 320 | (15.3) | 5 | (11.4) | 6 | (11.5) | 0.586 | - | - | - |
Liver cirrhosis | 45 | (2.2) | 1 | (2.3) | 1 | (1.9) | 0.992 | - | - | - |
Malignancy | 329 | (15.8) | 3 | (6.8) | 3 | (5.8) | 0.041 | - | 0.049 * | - |
COPD | 253 | (12.1) | 7 | (15.9) | 3 | (5.8) | 0.227 | - | - | - |
Cardiovascular risk factors, n (%) | ||||||||||
Arterial hypertension | 1630 | (78.1) | 35 | (79.5) | 37 | (71.2) | 0.478 | - | - | - |
Diabetes mellitus | 773 | (37.0) | 10 | (22.7) | 16 | (30.8) | 0.102 | - | - | - |
Hyperlipidemia | 621 | (29.7) | 20 | (45.5) | 21 | (40.4) | 0.022 | 0.024 * | 0.098 | 0.617 |
Smoking | ||||||||||
Current | 384 | (18.4) | 11 | (25.0) | 11 | (21.2) | 0.426 | - | - | - |
Former | 371 | (17.8) | 8 | (18.2) | 11 | (21.2) | - | - | - | |
Family history | 186 | (8.9) | 7 | (15.9) | 8 | (15.4) | 0.084 | - | - | - |
Entry criteria, n (%) | ||||||||||
Acute coronary syndrome | 525 | (25.1) | 16 | (36.4) | 28 | (53.8) | 0.001 | 0.091 | 0.001 | 0.087 |
Chronic coronary syndrome | 274 | (13.1) | 0 | (0.0) | 5 | (9.6) | 0.028 | 0.010 | 0.458 | 0.035 * |
Rhythm disorders | 469 | (22.5) | 12 | (27.3) | 15 | (28.9) | 0.425 | - | - | - |
Ventricular tachyarrhythmia | 0 | (0.0) | 4 | (9.1) | 11 | (21.2) | 0.001 | 0.001 | 0.001 | 0.105 |
Acute decompensated heart failure | 330 | (15.8) | 8 | (18.2) | 2 | (3.8) | 0.056 | - | 0.019 * | 0.022 * |
Valvular disease | 170 | (8.1) | 4 | (9.1) | 0 | (0.0) | 0.097 | - | 0.032 * | 0.026 * |
Pulmonary embolism | 28 | (1.3) | 1 | (2.3) | 0 | (0.0) | 0.606 | - | - | - |
Cardiomyopathy | 96 | (4.6) | 2 | (4.5) | 0 | (0.0) | 0.286 | - | - | - |
Elective cardiac procedure | 31 | (1.5) | 0 | (0.0) | 0 | (0.0) | 0.485 | - | - | - |
Others | 165 | (7.9) | 1 | (2.3) | 1 | (3.8) | 0.219 | - | - | - |
Comorbidities at index hospitalization, n (%) | ||||||||||
Acute coronary syndrome | ||||||||||
Unstable angina | 97 | (4.6) | 1 | (2.3) | 1 | (1.9) | 0.497 | - | - | - |
STEMI | 150 | (7.2) | 11 | (25.0) | 15 | (28.8) | 0.001 | 0.001 | 0.001 | 0.673 |
NSTEMI | 257 | (12.3) | 5 | (11.4) | 12 | (23.1) | 0.067 | - | - | - |
Acute decompensated heart failure | 464 | (22.2) | 11 | (25.0) | 9 | (17.3) | 0.631 | - | - | - |
Atrial fibrillation | 882 | (42.2) | 21 | (47.7) | 13 | (25.0) | 0.033 | 0.466 | 0.013 | 0.020 * |
Cardiopulmonary resuscitation | 25 | (1.2) | 1 | (2.3) | 27 | (51.9) | 0.001 | 0.520 | 0.001 | 0.001 |
Out-of-hospital | 7 | (0.3) | 0 | (0.0) | 15 | (28.8) | 0.001 | 0.700 | 0.001 | 0.001 |
In-hospital | 18 | (0.9) | 1 | (2.3) | 12 | (23.1) | 0.001 | 0.324 | 0.001 | 0.003 |
Stroke | 295 | (14.1) | 2 | (4.5) | 1 | (1.9) | 0.008 | 0.069 | 0.012 | 0.462 |
Implantation of cardiac devices during index hospitalization, n (%) | ||||||||||
ICD | 3 | (0.014) | 1 | (2.3) | 4 | (7.7) | 0.001 | 0.001 | 0.001 | 0.234 |
sICD | 2 | (0.096) | 2 | (4.5) | 5 | (9.6) | 0.001 | 0.001 | 0.001 | 0.341 |
CRT-D | 1 | (0.005) | 0 | (0.0) | 0 | (0.0) | 0.977 | - | - | - |
Medication on admission, n (%) | ||||||||||
ACE-inhibitor | 748 | (35.8) | 9 | (20.5) | 18 | (34.6) | 0.107 | - | - | - |
ARB | 468 | (22.4) | 10 | (22.7) | 11 | (21.2) | 0.976 | - | - | - |
Beta-blocker | 1183 | (56.7) | 23 | (52.3) | 28 | (53.8) | 0.783 | - | - | - |
Aldosterone antagonist | 197 | (9.4) | 3 | (6.8) | 6 | (11.5) | 0.733 | - | - | - |
ARNI | 19 | (0.9) | 0 | (0.0) | 0 | (0.0) | 0.644 | - | - | - |
SGLT2-inhibitor | 41 | (2.0) | 2 | (4.5) | 2 | (3.8) | 0.322 | - | - | - |
Loop diuretics | 794 | (38.0) | 12 | (27.3) | 15 | (28.8) | 0.145 | - | - | - |
Statin | 939 | (45.0) | 23 | (52.3) | 23 | (44.2) | 0.624 | - | - | - |
ASA | 704 | (33.7) | 14 | (31.8) | 17 | (32.7) | 0.955 | - | - | - |
P2Y12-inhibitor | 202 | (9.7) | 4 | (9.1) | 5 | (9.6) | 0.992 | - | - | - |
DOAC | 495 | (23.7) | 15 | (34.1) | 10 | (19.2) | 0.204 | - | - | - |
Vitamin K antagonist | 180 | (8.6) | 2 | (4.5) | 3 | (5.8) | 0.491 | - | - | - |
No Ventricular Arrhythmia (n = 2088) | nsVT (n = 44) | sVT/VF (n = 52) | p-Value across Groups | p-Value None vs. nsVT | p-Value None vs. sVT/VF | p-Value nsVT vs. sVT/VF | ||||
---|---|---|---|---|---|---|---|---|---|---|
Heart failure etiology, n (%) | 0.006 | 0.221 | 0.003 | 0.199 | ||||||
Ischemic heart disease | 1181 | (56.6) | 31 | (70.5) | 46 | (88.5) | ||||
Non-ischemic cardiomyopathy | 140 | (6.7) | 6 | (13.6) | 3 | (5.8) | ||||
Hypertensive cardiomyopathy | 177 | (8.5) | 1 | (2.3) | 0 | (0.0) | ||||
Congenital heart disease | 4 | (0.2) | 0 | (0.0) | 0 | (0.0) | ||||
Valvular heart disease | 94 | (4.5) | 2 | (4.5) | 0 | (0.0) | ||||
Tachycardia associated | 127 | (6.1) | 1 | (2.3) | 0 | (0.0) | ||||
Tachymyopathy | 38 | (1.8) | 0 | (0.0) | 0 | (0.0) | ||||
Pacemaker-induced cardiomyopathy | 19 | (0.9) | 0 | (0.0) | 0 | (0.0) | ||||
Unknown | 346 | (16.6) | 3 | (6.8) | 3 | (5.8) | ||||
NYHA functional class, n (%) | ||||||||||
I/II | 1515 | (72.6) | 30 | (68.2) | 40 | (76.9) | 0.073 | - | - | - |
III | 397 | (19.0) | 9 | (20.5) | 4 | (7.7) | ||||
IV | 176 | (8.4) | 5 | (11.4) | 8 | (15.4) | ||||
Echocardiographic data | ||||||||||
LVEF, %, median (IQR) | 45 (45–47) | 45 (44–47) | 45 (43–46) | 0.362 | - | - | - | |||
IVSd, median (IQR) | 12 (11–13) | 11 (10–13) | 12 (11–13) | 0.306 | - | - | - | |||
LVEDD, mm, median (IQR) | 49 (44–54) | 50 (47–56) | 50 (47–54) | 0.073 | - | - | - | |||
TAPSE, mm, median (IQR) | 20 (17–23) | 21 (18–23) | 20 (18–23) | 0.480 | - | - | - | |||
LA diameter, mm, median (IQR) | 42 (37–47) | 40 (36–52) | 41 (35–46) | 0.725 | - | - | - | |||
LA surface, cm2, median (IQR) | 22 (17–26) | 20 (17–24) | 20 (17–26) | 0.577 | - | - | - | |||
E/A, median (IQR) | 0.8 (0.6–1.2) | 0.8 (0.7–1.2) | 0.8 (0.7–1.1) | 0.800 | - | - | - | |||
E/E‘, median (IQR) | 9.3 (6.5–14.0) | 8.8 (5.3–11.0) | 10.5 (7.5–12.4) | 0.602 | - | - | - | |||
Diastolic dysfunction, n (%) | 1515 | (72.6) | 27 | (61.4) | 32 | (61.5) | 0.060 | - | - | - |
Moderate–severe aortic stenosis, n (%) | 207 | (9.9) | 4 | (9.1) | 3 | (5.8) | 0.603 | - | - | - |
Moderate–severe aortic regurgitation, n (%) | 79 | (3.8) | 2 | (4.5) | 3 | (5.8) | 0.741 | - | - | - |
Moderate–severe mitral regurgitation, n (%) | 252 | (12.1) | 3 | (6.8) | 7 | (13.5) | 0.540 | - | - | - |
Moderate–severe tricuspid regurgitation, n (%) | 336 | (16.1) | 4 | (9.1) | 4 | (7.7) | 0.123 | - | - | - |
VCI, mm, median (IQR) | 20 (15–25) | 17 (13–31) | 18 (14–22) | 0.459 | - | - | - | |||
Aortic root, mm, median (IQR) | 33 (30–36) | 32 (30–38) | 34 (30–35) | 0.927 | - | - | - | |||
Coronary angiography, n (%) | 826 | (39.6) | 28 | (63.6) | 46 | (88.5) | 0.001 | 0.001 | 0.001 | 0.004 |
No evidence of coronary artery disease | 166 | (20.1) | 3 | (10.7) | 6 | (13.0) | 0.009 | 0.002 | 0.594 | 0.033 * |
1-vessel disease | 146 | (17.1) | 13 | (46.4) | 7 | (15.2) | ||||
2-vessel disease | 177 | (21.4) | 4 | (14.3) | 11 | (23.9) | ||||
3-vessel disease | 337 | (40.8) | 8 | (28.6) | 22 | (47.8) | ||||
CABG | 63 | (7.6) | 5 | (17.9) | 5 | (10.9) | 0.117 | - | - | - |
Chronic total occlusion | 95 | (11.5) | 2 | (7.1) | 16 | (34.8) | 0.001 | 0.475 | 0.001 | 0.007 |
PCI, n (%) | 431 | (52.2) | 17 | (60.7) | 33 | (71.7) | 0.026 | 0.374 | 0.010 | 0.326 |
Sent to CABG, n (%) | 50 | (6.1) | 0 | (0.0) | 1 | (2.2) | 0.227 | - | - | - |
Baseline laboratory values, median (IQR) | ||||||||||
Potassium, mmol/L | 3.9 (3.6–4.2) | 3.8 (3.6–4.1) | 3.9 (3.7–4.2) | 0.780 | - | - | - | |||
Sodium, mmol/L | 139 (137–141) | 140 (138–142) | 140 (138–141) | 0.227 | - | - | - | |||
Creatinine, mg/dL | 1.07 (0.86–1.46) | 0.99 (0.85–1.46) | 0.97 (0.80–1.26) | 0.054 | - | - | - | |||
eGFR, mL/min/1.73 m2 | 65 (45–85) | 79 (47–92) | 79 (56–95) | 0.004 | 0.076 | 0.004 | 0.508 | |||
Hemoglobin, g/dL | 12.4 (10.4–14.0) | 12.7 (10.6–13.8) | 12.3 (10.4–14.2) | 0.895 | - | - | - | |||
WBC count, ×109/L | 8.16 (6.42–10.10) | 8.97 (6.78–10.17) | 8.89 (7.83–10.52) | 0.030 | 0.429 | 0.011 | 0.291 | |||
Platelet count, ×109/L | 225 (178–284) | 217 (153–285) | 269 (204–349) | 0.003 | 0.387 | 0.001 | 0.007 | |||
HbA1c, % | 5.9 (5.5–6.8) | 5.6 (5.5–6.3) | 5.9 (5.4–6.5) | 0.274 | - | - | - | |||
LDL-cholesterol, mg/dL | 99 (74–127) | 84 (73–128) | 81 (59–119) | 0.100 | - | - | - | |||
HDL-cholesterol, mg/dL | 42 (34–52) | 44 (34–50) | 37 (29–43) | 0.032 | 0.836 | 0.009 | 0.048 * | |||
C-reactive protein, mg/L | 13.1 (3.4–43.7) | 12.7 (3.2–36.6) | 17.4 (4.6–47.0) | 0.652 | - | - | - | |||
NT-pro BNP, pg/mL | 2682 (994–6811) | 2773 (1026–8560) | 1971 (1227–3500) | 0.802 | - | - | - | |||
NT-pro BNP (eGFR corrected), pg/mL | 1630 (652–3428) | 2300 (674–4848) | 1665 (1080–4267) | 0.502 | - | - | - | |||
Cardiac troponin I, µg/L | 0.03 (0.02–0.16) | 0.03 (0.02–3.19) | 0.03 (0.02–2.01) | 0.001 | 0.146 | 0.001 | 0.325 | |||
Medication at discharge, n (%) | ||||||||||
ACE-inhibitor | 1006 | (49.9) | 19 | (43.2) | 33 | (68.8) | 0.023 | 0.380 | 0.010 | 0.013 |
ARB | 479 | (23.7) | 11 | (25.0) | 9 | (18.8) | 0.707 | - | - | - |
Beta-blocker | 1548 | (76.7) | 39 | (88.6) | 48 | (100.0) | 0.001 | 0.064 | 0.001 | 0.016 |
Aldosterone antagonist | 279 | (13.8) | 5 | (11.4) | 12 | (25.0) | 0.078 | - | - | - |
ARNI | 24 | (1.2) | 1 | (2.3) | 0 | (0.0) | 0.600 | 0.516 | 0.447 | 0.294 |
SGLT2-inhibitor | 80 | (4.0) | 1 | (2.3) | 3 | (6.3) | 0.612 | 0.567 | 0.426 | 0.350 |
Loop diuretics | 981 | (48.6) | 17 | (38.6) | 20 | (41.7) | 0.275 | 0.189 | 0.340 | 0.767 |
Statin | 1367 | (67.8) | 36 | (81.8) | 39 | (81.3) | 0.021 | 0.048 * | 0.048 * | 0.944 |
Digitalis | 100 | (5.0) | 3 | (6.8) | 0 | (0.0) | 0.241 | - | - | - |
Amiodarone | 50 | (2.0) | 2 | (4.5) | 6 | (12.5) | 0.001 | 0.387 | 0.001 | 0.176 |
ASA | 1003 | (49.7) | 25 | (56.8) | 35 | (72.9) | 0.004 | 0.352 | 0.001 | 0.105 |
P2Y12-inhibitor | 611 | (30.3) | 22 | (50.0) | 35 | (72.9) | 0.001 | 0.005 | 0.001 | 0.024 * |
DOAC | 660 | (32.7) | 17 | (38.6) | 13 | (27.1) | 0.498 | - | - | - |
Vitamin K antagonist | 145 | (7.2) | 2 | (4.5) | 3 | (6.3) | 0.775 | - | - | - |
sVT/VF (n = 52) | ||
---|---|---|
Arrhythmia *, n (%) | ||
sVT | 16 | (30.8) |
VF | 27 | (51.9) |
Both | 9 | (17.3) |
Time of arrhythmia, n (%) | ||
On admission | 30 | (57.7) |
In-hospital | 22 | (42.3) |
Symptoms, n (%) | ||
None | 12 | (23.1) |
Dyspnea | 3 | (5.8) |
Angina pectoris | 13 | (25.0) |
Syncope | 11 | (21.2) |
CPR | 26 | (50.0) |
Arrhythmia termination, n (%) | ||
Spontaneous | 2 | (3.8) |
Amiodarone | 16 | (30.8) |
Cardioversion | 5 | (9.6) |
Defibrillation | 40 | (76.9) |
Termination refused (DNR) | 1 | (1.9) |
No Ventricular Arrhythmia (n = 2088) | nsVT (n = 44) | sVT/VF (n = 52) | HR None vs. nsVT | 95% CI None vs. nsVT | p Value None vs. nsVT | HR None vs. sVT/VF | 95% CI None vs. sVT/VF | p Value None vs. sVT/VF | p Value nsVT vs. sVT/VF | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Primary endpoint, n (%) | |||||||||||||
All-cause mortality, at 30 months | 657 | (31.5) | 11 | (25.0) | 15 | (28.8) | 0.760 | 0.419–1.380 | 0.367 | 0.928 | 0.556–1.549 | 0.776 | - |
Secondary endpoints, n (%) | - | ||||||||||||
All-cause mortality, in-hospital | 71 | (3.4) | 0 | (0.0) | 4 | (7.7) | - | - | - | 2.092 | 0.763–5.737 | 0.151 | - |
Cardiovascular mortality, in-hospital | 31 | (1.5) | - | (-) | 4 | (7.7) | - | - | - | 4.587 | 1.618–13.003 | 0.004 | - |
Non-cardiovascular mortality, in-hospital | 40 | (1.9) | - | (-) | - | (-) | - | - | - | - | - | - | - |
Malignancy-associated mortality, in-hospital | 14 | (0.7) | - | (-) | - | (-) | - | - | - | - | - | - | - |
All-cause mortality, at 12 months | 448 | (21.5) | 8 | (18.2) | 10 | (19.2) | 0.811 | 0.403–1.631 | 0.557 | 0.914 | 0.488–1.711 | 0.779 | - |
Heart failure-related rehospitalization, at 30 months | 266 | (13.2) | 6 | (13.6) | 7 | (14.6) | 1.046 | 0.466–2.349 | 0.914 | 1.112 | 0.525–2.354 | 0.782 | - |
Cardiac rehospitalization, at 30 months | 435 | (21.6) | 12 | (27.3) | 15 | (31.3) | 1.338 | 0.754–2.375 | 0.319 | 1.542 | 0.921–2.580 | 0.099 | - |
Revascularization, at 30 months | 133 | (6.6) | 4 | (9.1) | 5 | (10.4) | 1.407 | 0.501 | 1.637 | 0.670–3.997 | 0.279 | - | |
Acute myocardial infarction, at 30 months | 60 | (3.0) | 1 | (2.3) | 3 | (6.3) | 0.770 | 0.107–5.553 | 0.795 | 2.145 | 0.673–6.840 | 0.197 | - |
Stroke, at 30 months | 56 | (2.8) | 0 | (0.0) | 1 | (2.1) | - | - | - | 0.758 | 0.105–5.472 | 0.783 | - |
MACCE, at 30 months | 805 | (38.6) | 15 | (34.1) | 21 | (40.4) | 0.857 | 0.514–1.427 | 0.552 | 1.112 | 0.721–1.715 | 0.631 | - |
Follow-up data, median (IQR) | |||||||||||||
Hospitalization time, days | 9 (5–15) | 9 (6–17) | 11 (7–16) | - | - | 0.585 | - | - | 0.053 | 0.282 | |||
ICU time, days | 0 (0–1) | 1 (0–2) | 2 (1–5) | - | - | 0.001 | - | - | 0.001 | 0.001 | |||
Follow-up time, days | 900 (365–1650) | 1103 (358–1504) | 846 (339–1748) | - | - | 0.649 | - | - | 0.713 | 0.944 |
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Schmitt, A.; Behnes, M.; Rusnak, J.; Akin, M.; Reinhardt, M.; Abel, N.; Forner, J.; Müller, J.; Weidner, K.; Abumayyaleh, M.; et al. Characteristics Associated with Ventricular Tachyarrhythmias and Their Prognostic Impact in Heart Failure with Mildly Reduced Ejection Fraction. J. Clin. Med. 2024, 13, 2665. https://doi.org/10.3390/jcm13092665
Schmitt A, Behnes M, Rusnak J, Akin M, Reinhardt M, Abel N, Forner J, Müller J, Weidner K, Abumayyaleh M, et al. Characteristics Associated with Ventricular Tachyarrhythmias and Their Prognostic Impact in Heart Failure with Mildly Reduced Ejection Fraction. Journal of Clinical Medicine. 2024; 13(9):2665. https://doi.org/10.3390/jcm13092665
Chicago/Turabian StyleSchmitt, Alexander, Michael Behnes, Jonas Rusnak, Muharrem Akin, Marielen Reinhardt, Noah Abel, Jan Forner, Julian Müller, Kathrin Weidner, Mohammad Abumayyaleh, and et al. 2024. "Characteristics Associated with Ventricular Tachyarrhythmias and Their Prognostic Impact in Heart Failure with Mildly Reduced Ejection Fraction" Journal of Clinical Medicine 13, no. 9: 2665. https://doi.org/10.3390/jcm13092665