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

Publication ,  Journal Article
Friedman, DJ; Fudim, M; Overton, R; Shaw, LK; Patel, D; Pokorney, SD; Velazquez, EJ; Al-Khatib, SM
Published in: Am Heart J
July 2018

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.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2018

Volume

201

Start / End Page

17 / 24

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Risk Factors
  • Retrospective Studies
  • Primary Prevention
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine
  • Humans
  • Heart Ventricles
 

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Friedman, D. J., Fudim, M., Overton, R., Shaw, L. K., Patel, D., Pokorney, S. D., … Al-Khatib, S. M. (2018). The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients. Am Heart J, 201, 17–24. https://doi.org/10.1016/j.ahj.2018.03.017
Friedman, Daniel J., Marat Fudim, Robert Overton, Linda K. Shaw, Divyang Patel, Sean D. Pokorney, Eric J. Velazquez, and Sana M. Al-Khatib. “The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients.Am Heart J 201 (July 2018): 17–24. https://doi.org/10.1016/j.ahj.2018.03.017.
Friedman DJ, Fudim M, Overton R, Shaw LK, Patel D, Pokorney SD, et al. The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients. Am Heart J. 2018 Jul;201:17–24.
Friedman, Daniel J., et al. “The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients.Am Heart J, vol. 201, July 2018, pp. 17–24. Pubmed, doi:10.1016/j.ahj.2018.03.017.
Friedman DJ, Fudim M, Overton R, Shaw LK, Patel D, Pokorney SD, Velazquez EJ, Al-Khatib SM. The relationship between baseline and follow-up left ventricular ejection fraction with adverse events among primary prevention ICD patients. Am Heart J. 2018 Jul;201:17–24.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2018

Volume

201

Start / End Page

17 / 24

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Risk Factors
  • Retrospective Studies
  • Primary Prevention
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine
  • Humans
  • Heart Ventricles