Author + information
- Tariq Ahmad, MD, MPH and
- G. Michael Felker, MD, MHS∗ ()
- ↵∗Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, DUMC Box 3850, Durham, North Carolina 27710
We thank Dr. Weir for the insightful comments in regard to our recent report (1). We wholeheartedly agree with the assertion that biomarkers may play a role in prediction of risk of sudden cardiac death in combination with electrical and structural assessments of the heart.
It would be expected that inclusion of specifics of the surface electrocardiogram such as QT variability and novel imaging modalities such as late gadolinium enhancement on cardiac magnetic resonance could potentially add both accuracy and precision to the prediction of sudden cardiac death. However, such detailed phenotyping was not performed in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) study. Furthermore, patients with chronic heart failure have an increased risk of death from a variety of causes other than sudden cardiac death, and extremely accurate predictors of one mode of death might not be clinically feasible in the setting of these competing risks. Risk of sudden cardiac death is also not static, and frequent detailed assessments of cardiac structure and electrocardiography may not be practical in the clinical setting. With these unanswered questions in mind, there is an unmet need to compare various predictors of sudden cardiac death to assess their comparative prognostic and cost effectiveness.
Please note: Dr. Ahmad has received support from the Daland Fellowship in Clinical Investigation and a training grant from the NHLBI (T32HL069749). The HF-ACTION study was funded by grants from the NHLBI. The biomarkers assays were funded by grants from Roche Diagnostics, BG Medicine, and Critical Diagnostics. Dr. Felker has received research funding from BG Medicine, Critical Diagnostics, and Roche Diagnostics; and has served as a consultant for BG Medicine, Singulex, and Roche Diagnostics.
- American College of Cardiology Foundation