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

Autor: Friedman DJ; Division of Cardiology, Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University Hospital, Durham, NC. Electronic address: daniel.friedman@duke.edu., Fudim M; Division of Cardiology, Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University Hospital, Durham, NC., Overton R; Duke Clinical Research Institute, Durham, NC., Shaw LK; Duke Clinical Research Institute, Durham, NC., Patel D; Department of Medicine, Duke University Hospital, Durham, NC., Pokorney SD; Division of Cardiology, Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University Hospital, Durham, NC., Velazquez EJ; Division of Cardiology, Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University Hospital, Durham, NC; Cardiac Diagnostic Unit, Duke University Hospital, Durham, NC., Al-Khatib SM; Division of Cardiology, Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University Hospital, Durham, NC.
Jazyk: angličtina
Zdroj: American heart journal [Am Heart J] 2018 Jul; Vol. 201, pp. 17-24. Date of Electronic Publication: 2018 Apr 04.
DOI: 10.1016/j.ahj.2018.03.017
Abstrakt: 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.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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