Spontaneous Non-Sustained Ventricular Tachycardia and Premature Ventricular Contractions and Their Prognostic Relevance in Patients with Cancer in Routine Care
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Study Population
2.2. 24-h Electrocardiograms
2.3. Statistical Analyses
3. Results
3.1. Study Population
3.2. 24-h Electrocardiograms
3.3. Comparing Patients with and without Ventricular Arrhythmias
3.4. Comparing Patients with and without Death during Follow-Up
3.5. Survival Analyses
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Healthy Controls (n = 35) | Cancer Patients (n = 261) | p-Value | Cancer Deaths (n = 158) | Cancer Survivors (n = 103) | p-Value |
---|---|---|---|---|---|---|
Clinical characteristics | ||||||
Age (years) | 68 ± 6 (IQR 62–73) | 68 ± 12 (IQR 61–76) | 0.86 | 69 ± 10 (IQR 62–75) | 65 ± 17 (IQR 58–76) | 0.016 |
Female sex, n (%) | 19 (54) | 132 (51) | 0.68 | 76 (48) | 56 (54) | 0.32 |
BMI (kg/m2) | 26 ± 4 | 24 ± 5 | 0.28 | 25 ± 5 | 26 ± 5 | 0.049 |
Cancer stage ≥III, n (%) | – | 188 (72) | – | 123 (78) | 65 (63) | 0.0095 |
Cancer type: solid, n (%) | – | 129 (49) | – | 93 (59) | 36 (35) | 0.0002 |
ECOG performance status ≥2, n (%) | – | 111 (43) | – | 75 (47) | 36 (35) | 0.046 |
Prior potentially cardiotoxic anti-cancer drugs, n (%) | – | 162 (62) | – | 104 (66) | 58 (56) | 0.12 |
Left ventricular ejection fraction (%) | 64 ± 7 | 65 ± 7 (n = 181) | 0.81 | 64 ± 8 (n = 100) | 65 ± 7 (n = 81) | 0.27 |
Laboratory parameters | ||||||
Haemoglobin (g/dL) | 14.2 ± 1.3 | 10.8 ± 2.0 | <0.0001 | 10.6 ± 1.9 | 11.1 ± 2.1 | 0.040 |
Leucocytes (/nL) | 6.6 (5.5–7.6) | 6.5 (4.3-9.6) | 0.99 | 6.9 (4.4–9.9) | 6.1 (4.3–9.2) | 0.40 |
Platelets (/nL) | 227 ± 46 | 225 ± 166 | 0.97 | 231 ± 195 | 217 ± 108 | 0.48 |
Sodium (mmol/L) | 141 ± 2 | 139 ± 4 | 0.0002 | 138 ± 4 | 140 ± 3 | 0.0027 |
Potassium (mmol/L) | 4.2 ± 0.4 | 3.9 ± 0.5 | 0.0004 | 3.9 ± 0.5 | 3.9 ± 0.5 | 0.91 |
Creatinine (mg/dL) | 0.87 ± 0.19 | 1.00 ± 0.59 | 0.22 | 1.03 ± 0.68 | 0.94 ± 0.40 | 0.23 |
GOT (U/L) | 26 (22–28) | 26 (19-37) (n = 171) | 0.75 | 27 (19–39) (n = 101) | 25 (19–34) (n = 70) | 0.34 |
Secondary diagnoses | ||||||
Arterial hypertension, n (%) | 7 (20) | 132 (51) | 0.0007 | 79 (50) | 53 (51) | 0.82 |
Coronary artery disease, (%) | 0 | 34 (13) | 0.0040 | 22 (14) | 12 (12) | 0.59 |
Atrial fibrillation, n (%) | 0 | 14 (5) | 0.08 | 8 (5) | 6 (6) | 0.79 |
Previous myocardial infarction, n (%) | 0 | 20 (8) | 0.033 | 13 (8) | 7 (7) | 0.67 |
Diabetes mellitus type 2, n (%) | 0 | 50 (19) | 0.0003 | 31 (20) | 19 (18) | 0.81 |
Chronic kidney disease, n (%) | 0 | 41 (16) | 0.0014 | 28 (18) | 13 (13) | 0.27 |
Previous stroke, n (%) | 0 | 27 (10) | 0.011 | 17 (11) | 10 (10) | 0.79 |
Current use of antibiotics, n (%) | 0 | 45 (17) | 0.0007 | 33 (21) | 12 (12) | 0.054 |
24 h-ECG | ||||||
Average 24 h heart rate (bpm) | 70 ± 9 | 78 ± 14 | 0.0007 | 79 ± 16 | 77 ± 11 | 0.41 |
No. of premature atrial contractions/24 h | 82 (27–302) | 195 (27–1167) | 0.22 | 227 (32–1226) | 146 (24–761) | 0.20 |
No. of premature ventricular contractions/24 h | 9 (1–43) | 26 (2–360) | 0.06 | 54 (4–467) | 12 (1–280) | 0.013 |
≥20 Premature ventricular contractions/24 h, n (%) | 13 (37) | 139 (53) | 0.07 | 95 (60) | 44 (43) | 0.0059 |
≥50 Premature ventricular contractions/24 h, n (%) | 8 (23) | 117 (45) | 0.013 | 80 (51) | 37 (36) | 0.020 |
NSVT with ≥3 beats & ≥100 bpm, n (%) | 0 | 44 (17) | 0.0008 | 31 (20) | 13 (13) | 0.14 |
NSVT with ≥4 beats & ≥100 bpm, n (%) | 0 | 25 (10) | 0.016 | 21 (13) | 4 (4) | 0.0066 |
Variable | Univariate Model | |||||||
HR | 95% CI | χ2 | p-Value | |||||
Significant and Clinically Relevant Variables | ||||||||
NSVT ≥4 beats & ≥100 bpm (yes vs. no) | 1.66 | 1.04–2.63 | 4.6 | 0.033 | ||||
≥20 Premature ventricular contractions/24 h (yes vs. no) | 1.67 | 1.21–2.30 | 9.9 | 0.0017 | ||||
Age (per 1 year) | 1.01 | 1.001–1.03 | 4.3 | 0.039 | ||||
BMI (per 1 kg/m2) | 0.95 | 0.91–0.98 | 8.1 | 0.0043 | ||||
Cancer stage (≥III vs. I/II) | 1.66 | 1.14–2.42 | 7.0 | 0.0082 | ||||
Cancer type (solid vs. haematologic) | 2.09 | 1.52–2.87 | 20.3 | <0.0001 | ||||
ECOG performance status (≥2 vs. 0/1) | 1.58 | 1.15–2.17 | 8.2 | 0.0043 | ||||
Haemoglobin (per 1 g/dL) | 0.91 | 0.84–0.99 | 5.3 | 0.021 | ||||
Sodium (per 1 mmol/L) | 0.94 | 0.90–0.98 | 10.4 | 0.0013 | ||||
Opioids (yes vs. no) | 1.67 | 1.13–2.47 | 6.7 | 0.0097 | ||||
Antidepressants (yes vs. no) | 1.85 | 1.14–2.99 | 6.2 | 0.013 | ||||
Prior potentially cardiotoxic anti-cancer drugs (yes vs. no) | 1.41 | 1.02–1.96 | 4.2 | 0.039 | ||||
Sex (female vs. male) | 0.80 | 0.59–1.10 | 1.9 | 0.17 | ||||
Potassium (per 1 mmol/L) | 1.07 | 0.78–1.48 | 0.2 | 0.66 | ||||
Current use of antibiotics (yes vs. no) | 1.29 | 0.88–1.90 | 1.7 | 0.19 | ||||
Coronary artery disease (yes vs. no) | 0.99 | 0.63–1.56 | 0.001 | 0.98 | ||||
Variable | Multivariate Model 1 | Multivariate Model 2 | ||||||
HR | 95% CI | χ2 | p-Value | HR | 95% CI | χ2 | p-Value | |
Multivariate Survival Analyses in Cancer Patients with NSVT ≥4 beats & ≥100 bpm | ||||||||
NSVT ≥4 beats & ≥100 bpm (yes vs. no) | 1.82 | 1.13–2.94 | 6.0 | 0.015 | 1.76 | 1.09–2.84 | 5.3 | 0.022 |
Age (per 1 year) | 1.02 | 1.01–1.04 | 8.4 | 0.0038 | 1.02 | 1.01–1.04 | 8.2 | 0.0041 |
Sodium (per 1 mmol/L) | 0.96 | 0.92–1.002 | 3.5 | 0.061 | 0.96 | 0.92–1.003 | 3.4 | 0.07 |
Haemoglobin (per 1 g/dL) | 0.92 | 0.84–1.0003 | 3.8 | 0.051 | 0.92 | 0.84–1.004 | 3.5 | 0.06 |
BMI (per 1 kg/m2) | 0.96 | 0.93–0.996 | 4.7 | 0.031 | 0.96 | 0.92–0.998 | 4.2 | 0.041 |
Opioids (yes vs. no) | 1.33 | 0.88–2.03 | 1.8 | 0.18 | 1.33 | 0.87–2.04 | 1.7 | 0.19 |
Antidepressants (yes vs. no) | 1.50 | 0.91–2.47 | 2.6 | 0.11 | 1.60 | 0.97–2.64 | 3.4 | 0.07 |
Cancer stage (≥III vs. I/II) | 1.50 | 1.01–2.21 | 4.1 | 0.043 | 1.52 | 1.03–2.24 | 4.4 | 0.037 |
Cancer type (solid vs. haematologic) | 2.46 | 1.75–3.46 | 26.9 | <0.0001 | 2.54 | 1.80–3.59 | 27.7 | <0.0001 |
ECOG performance status (≥2 vs. 0/1) | 1.23 | 0.87–1.73 | 1.4 | 0.24 | 1.40 | 0.97–2.01 | 3.3 | 0.07 |
Prior potentially cardiotoxic anti-cancer drugs (yes vs. no) | 1.68 | 1.18–2.40 | 8.2 | 0.0041 | 1.70 | 1.19–2.43 | 8.4 | 0.0037 |
Sex (female vs. male) | 0.68 | 0.48–0.95 | 5.1 | 0.024 | ||||
Potassium (per 1 mmol/L) | 1.15 | 0.83–1.59 | 0.7 | 0.40 | ||||
Current use of antibiotics (yes vs. no) | 1.33 | 0.88–1.99 | 1.8 | 0.18 | ||||
Coronary artery disease (yes vs. no) | 1.02 | 0.62–1.67 | 0.004 | 0.95 | ||||
Multivariate Survival Analyses in Cancer Patients with ≥20 Premature Ventricular Contractions | ||||||||
≥20 Premature ventricular contractions/24 h (yes vs. no) | 1.71 | 1.22–2.40 | 9.7 | 0.0019 | 1.63 | 1.15–2.31 | 7.4 | 0.0064 |
Age (per 1 year) | 1.01 | 0.9991–1.03 | 3.4 | 0.07 | 1.02 | 0.99995–1.03 | 3.8 | 0.05 |
Sodium (per 1 mmol/L) | 0.97 | 0.92–1.008 | 2.6 | 0.11 | 0.96 | 0.92–1.008 | 2.6 | 0.11 |
Haemoglobin (per 1 g/dL) | 0.91 | 0.83–0.989 | 4.9 | 0.027 | 0.91 | 0.83–0.991 | 4.7 | 0.031 |
BMI (per 1 kg/m2) | 0.96 | 0.92–0.993 | 5.3 | 0.021 | 0.96 | 0.92–0.996 | 4.6 | 0.032 |
Opioids (yes vs. no) | 1.21 | 0.80–1.84 | 0.84 | 0.36 | 1.22 | 0.79–1.86 | 0.8 | 0.37 |
Antidepressants (yes vs. no) | 1.60 | 0.97–2.64 | 3.5 | 0.06 | 1.67 | 1.01–2.75 | 4.1 | 0.044 |
Cancer stage (≥III vs. I/II) | 1.64 | 1.11–2.42 | 6.1 | 0.014 | 1.63 | 1.10–2.41 | 6.0 | 0.014 |
Cancer type (solid vs. haematologic) | 2.44 | 1.74–3.43 | 26.5 | <0.0001 | 2.49 | 1.77–3.52 | 27.0 | <0.0001 |
ECOG performance status (≥2 vs. 0/1) | 1.30 | 0.92–1.84 | 2.3 | 0.13 | 1.47 | 1.02–2.11 | 4.4 | 0.037 |
Prior potentially cardiotoxic anti-cancer drugs (yes vs. no) | 1.53 | 1.07–2.17 | 5.5 | 0.019 | 1.54 | 1.08–2.20 | 5.6 | 0.018 |
Sex (female vs. male) | 0.69 | 0.49–0.97 | 4.6 | 0.03 | ||||
Potassium (per 1 mmol/L) | 1.14 | 0.83–1.57 | 0.6 | 0.42 | ||||
Current use of antibiotics (yes vs. no) | 1.24 | 0.82–1.86 | 1.0 | 0.31 | ||||
Coronary artery disease (yes vs. no) | 0.91 | 0.55–1.50 | 0.1 | 0.71 |
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Albrecht, A.; Porthun, J.; Eucker, J.; Coats, A.J.S.; von Haehling, S.; Pezzutto, A.; Karakas, M.; Riess, H.; Keller, U.; Landmesser, U.; et al. Spontaneous Non-Sustained Ventricular Tachycardia and Premature Ventricular Contractions and Their Prognostic Relevance in Patients with Cancer in Routine Care. Cancers 2021, 13, 2303. https://doi.org/10.3390/cancers13102303
Albrecht A, Porthun J, Eucker J, Coats AJS, von Haehling S, Pezzutto A, Karakas M, Riess H, Keller U, Landmesser U, et al. Spontaneous Non-Sustained Ventricular Tachycardia and Premature Ventricular Contractions and Their Prognostic Relevance in Patients with Cancer in Routine Care. Cancers. 2021; 13(10):2303. https://doi.org/10.3390/cancers13102303
Chicago/Turabian StyleAlbrecht, Annemarie, Jan Porthun, Jan Eucker, Andrew J.S. Coats, Stephan von Haehling, Antonio Pezzutto, Mahir Karakas, Hanno Riess, Ulrich Keller, Ulf Landmesser, and et al. 2021. "Spontaneous Non-Sustained Ventricular Tachycardia and Premature Ventricular Contractions and Their Prognostic Relevance in Patients with Cancer in Routine Care" Cancers 13, no. 10: 2303. https://doi.org/10.3390/cancers13102303