The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients

Friedman, Daniel J.; Fudim, Marat; Overton, Robert; Shaw, Linda K.; Patel, Divyang; Pokorney, Sean D.; Velázquez, Eric J.; Al‐Khatib, Sana M.

doi:10.1016/j.ahj.2018.03.017

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…All-cause mortality of 30.5% in the Townsville district was 1.2 to 2 times higher than mortality reported in other cohort studies in Australia, New Zealand, North America and Europe (15,(17)(18)(19)(20). Although we found no significant difference in mortality between the ICM and NICM patients, the total mortality in ICM patients was 1.4 to 2.4 times those in the MADIT, MADIT II, and MUST trials (21,22), and 1.3 to 2.8 times higher in the NICM patients compared to the CAT, AMIOVIRT, DEFINITE, and recent DANISH trials (23-26).…”

Section: Mortality Was Higher In Regional North Queenslandcontrasting

confidence: 56%

“…However, in our study 67 patients did not experience ventricular arrhythmias over the duration of 4.8 years, which needs to be taken into consideration when determining a therapy's success rate. An appropriate therapy rate of 18% sits at the lower end of the published range of 11.6 to 24% over 2.1-3.64 years follow-up (11,15,19,20,(28)(29)(30)(31). In a large randomized control trial of 2,521 patients Bardy showed a 21% appropriate shock rate in the ICD arm (32,33).…”

Section: Only 19% Of Patients Received Appropriate Icd Therapymentioning

confidence: 99%

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Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective

Engstrom

Dobson

et al. 2020

Front. Cardiovasc. Med.

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Background: Despite major advances in treating patients with severe heart failure, deciding who should receive an implantable cardiac defibrillator (ICD) remains challenging. Objective: To study the risk factors and mortality in patients after receiving an ICD (January 2008-December 2015) in a regional hospital in Australia. Methods: Eighty-two primary prevention patients received an ICD for ischemic cardiomyopathy (ICM, n = 41) and non-ischemic cardiomyopathy (NICM, n = 40) with 4.8-yrs follow-up. One patient had mixed ICM/NICM indications. Ventricular arrhythmias were assessed using intracardiac electrograms. Statistical analysis compared the total population and ICM and NICM groups using Kaplan-Meier for survival, Cox regression for mortality predictors, and binary logistic regression for predictors of ventricular arrhythmias (p < 0.05). Results: Major risk factors were hypercholesterolemia (70.7%), hypertension (47.6%), and obesity (41.5%). Severe obstructive sleep apnea (OSA) was found exclusively in NICM patients (23.7%, p = 0.001). Mortality was 30.5% after 4.8-yrs. The majority of patients (n=67) had no sustained ventricular arrhythmias yet 28% received therapy (n = 23), 18.51% were appropriate (n = 15), and 13.9% inappropriate (n = 11). Patients receiving ≥2 incidences of inappropriate shocks were 18-times more likely to die (p = 0.013). Three sudden cardiac deaths (SCD) (3.7%) were prevented by the ICD. Conclusion: Patients implanted with an ICD in Townsville had 30.5% all-cause mortality after 4.8-yrs. Only 28% of patients received ICD therapy and 13.9% were inappropriate. OSA may have contributed to the fourfold increase in inappropriate therapy in NICM patients. Our study raises important efficacy, ethical and healthcare cost questions about who should receive an ICD, and possible regional and urban center disparities.

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Section: Mortality Was Higher In Regional North Queenslandcontrasting

confidence: 56%

Section: Only 19% Of Patients Received Appropriate Icd Therapymentioning

confidence: 99%

Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective

Engstrom

Dobson

et al. 2020

Front. Cardiovasc. Med.

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“…77 • An improvement in LVEF during long-term follow-up is a frequent finding after implant of an ICD, even above 35%, but it is not associated with lack of appropriate device interventions for malignant ventricular tachyarrhythmias thus suggesting that the risk of ventricular tachyarrhythmias and SCD is modulated by pharmacological treatments, but a residual risk persists, along with time, that in appropriate patients may surely benefit from the rescue role of a back-up ICD. [78][79][80][81] • In patients implanted with an ICD or a CRT-D appropriate ICD shocks (especially when clustered into electrical storms) are associated with a significant increase in the subsequent risk of all-cause death 82,83 and therefore the occurrence of shocks, even if appropriate, should be considered a warning sign of a worsening prognosis. 84 Implementation of sacubitril/valsartan is in these cases absolutely appropriate in order to implement the favourable effects of this agent on ventricular tachyarrhythmias.…”

Section: Sacubitril/valsartan: Impact On Cardiovascular Mortality and On Sudden Cardiac Deathmentioning

confidence: 99%

Sinergy between drugs and devices in the fight against sudden cardiac death and heart failure

Boriani

Ponti

Guerra

et al. 2020

European Journal of Preventive Cardiology

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The impact of sudden cardiac death (SCD) in heart failure (HF) patients is important and prevention of SCD is a reasonable and clinically justified endpoint if associated with a reduction in all-cause mortality. According to literature, in HF with reduced ejection fraction, only three classes of agents were found effective in reducing SCD and all-cause mortality: beta-blockers, mineralcorticoid receptor antagonists and, more recently, angiotensin-receptor neprilysin-inhibitors. In the PARADIGM trial that tested sacubitril/valsartan vs. enalapril, the 20% relative risk reduction in cardiovascular deaths obtained with sacubitril/valsartan was attributable to reductions in the incidence of both SCD and death due to HF worsening and this effect can be added to the known positive effect of implantable cardioverter-defibrillators in appropriately selected patients. In order to maximize the implementation of all the available treatments, patients with HF should be included in virtuous networks with a dialogue between all the physician involved, with commitment by all these physicians for appropriate decision-making on application of pharmacological and device treatments according to available evidence, as well as commitment for drug titration before and after device implant, taking advantage from remote monitoring, and with the safety of back up device therapy when indicated. There are potential synergistic effects of drug therapy, with all the therapies acting on neuro-hormonal and sympathetic activation, but specifically with sacubitril/valsartan, and device therapy, in particular cardiac resynchronization therapy, with added incremental benefits on positive cardiac remodelling, prevention of HF progression, and prevention of ventricular tachyarrhythmias.

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“…Decreased LVEF imposes an elevated risk for clinical events that can coincidently benefit from optimal medical treatments, complicating the interpretation of LVEF for outcome prediction in secondary prevention. 27 However, CRC is valuable for monitoring medical therapy for secondary prevention of HF. Therefore, these findings would also extend the clinical implications of CRC as a prognostic indicator to patients with HF undergoing medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of the contraction–relaxation coupling index in outcome prediction for patients with acute heart failure

et al. 2022

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Aims Contemporary heart failure (HF) classification based on left ventricular (LV) ejection fraction is limited for comprehensive assessment of LV function. We aimed to validate the feasibility of the contraction-relaxation coupling index (CRC) as a novel predictor for clinical outcomes in patients with acute HF. Methods and results A total of 3266 consecutive patients (median age: 74 years, 53% male) with acute HF were included. CRC was defined as the ratio of end-diastolic elastance (LV end-diastolic pressure/stroke volume) to end-systolic elastance (LV end-systolic pressure/end-systolic volume). The risk for 1 year composite endpoint of all-cause mortality or hospitalization for HF (primary outcome) was compared after group categorization using CRC tertiles (Tertile 1: CRC ≤ 0.17, Tertile 2: 0.17 < CRC ≤ 0.40, and Tertile 3: 0.40 < CRC). The median CRC was 0.3 and the median LVEF was 42%. After adjustment for clinical and echocardiographic covariates, CRC was an independent predictor for the primary outcome (hazard ratio [

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The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients

Abstract: Among primary prevention ICD recipients, both baseline and follow-up LVEF were independently associated with long-term risk for appropriate ICD therapy, but they were not associated with time to the composite of LVAD, transplant, or death.

Cited by 6 publications

References 19 publications

Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective

Primary Prevention Implantable Cardiac Defibrillators: A Townsville District Perspective

Sinergy between drugs and devices in the fight against sudden cardiac death and heart failure

Feasibility of the contraction–relaxation coupling index in outcome prediction for patients with acute heart failure

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