The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients - 18/06/18
, Marat Fudim, MD a, b, c, Robert Overton, MAS b, Linda K. Shaw, MS b, Divyang Patel, MD c, Sean D. Pokorney, MD, MBA a, b, c, Eric J. Velazquez, MD a, b, c, d, Sana M. Al-Khatib, MD, MHS a, b, cAbstract |
Background |
Left ventricular ejection fraction (LVEF) is used to select patients for primary prevention implantable cardioverter defibrillators (ICDs). The relationship between baseline and long-term follow-up LVEF and clinical outcomes among primary prevention ICD patients remains unclear.
Methods |
We studied 195 patients with a baseline LVEF ≤35% ≤6 months prior to ICD implantation and follow-up LVEF 1–3 years after ICD implantation without intervening left ventricular assist device (LVAD) or transplant. The co-primary study endpoints were: (1) a composite of time to death, LVAD, or transplant and (2) appropriate ICD therapy. We examined multivariable Cox proportional hazard models with a 3-year post-implant landmark view; the LVEF closest to the 3-year mark was considered the follow-up LVEF for analyses. Follow-up LVEF was examined using 2 definitions: (1) ≥10% improvement compared to baseline or (2) actual value of ≥40%.
Results |
Fifty patients (26%) had a LVEF improvement of ≥10% and 44 (23%) had a follow-up LVEF ≥40%. Neither baseline nor follow-up LVEF was significantly associated with the composite endpoint. In contrast, both baseline and follow-up LVEF were associated with risk for long-term ICD therapies, whether follow-up LVEF was modeled as a ≥10% absolute improvement (baseline LVEF HR 0.87, CI 0.91–0.93, P < .001; follow-up LVEF HR 0.18, CI 0.06–0.53, P = .002) or a ≥40% follow-up value (baseline LVEF HR 0.89, CI 0.83–0.96, P = .001, follow-up LVEF HR 0.26, CI 0.08–0.87, P = .03).
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Plan
| Funding: Dr. Friedman received salary support through the NIH T32 training grant HL069749. |
|
| Conflicts of Interest: DJ Friedman reports educational grants from Boston Scientific and St Jude Medical, research grants from the National Cardiovascular Data Registry, and salary support through NIH T32 training grant HL069749–13. M Fudim reports research funding from AHA; and consulting services for Coridea and Cibiem. SD Pokorney reports research grants from Gilead, Boston Scientific, Pfizer, Bristol-Myers Squibb, Janssen Pharmaceuticals, and the Food and Drug Administration; consulting support from Boston Scientific, Medtronic, Pfizer, and Bristol Myers-Squibb. EJ Velazquez reports research grants from NHLBI, Alnylam Pharmaceuticals, Amgen, Novartis Pharmaceutical Corp., Pfizer; consulting services for Amgen, Merck & Co., Novartis Pharmaceutical Corp.; and speakers bureau honoraria from Expert Exchange. The rest of the authors have nothing to disclose. |
Vol 201
P. 17-24 - juillet 2018 Retour au numéro
Article précédent
- Bivalirudin versus heparin with primary percutaneous coronary intervention
- Dimitrios Venetsanos, Sofia Sederholm Lawesson, Stefan James, Sasha Koul, David Erlinge, Eva Swahn, Joakim Alfredsson
- Incidence, timing, and type of first and recurrent ischemic events in patients with and without peripheral artery disease after an acute coronary syndrome
- Taku Inohara, Karen Pieper, Daniel M. Wojdyla, Manesh R. Patel, William Schuyler Jones, Pierluigi Tricoci, Kenneth W. Mahaffey, Stefan K. James, John H. Alexander, Renato D. Lopes, Lars Wallentin, Erik Magnus Ohman, Matthew T. Roe, Sreekanth Vemulapalli
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?