Author + information
- Daniel J. Friedmana,b,
- Robert Overtona,b,
- Linda Shawa,b,
- Marat Fudima,b,
- Divyang Patela,b,
- Eric Velazqueza,b and
- Sana Al-Khatiba,b
Background: Ejection fraction (EF) is used to risk stratify implantable cardioverter defibrillator (ICD) candidates. The clinical utility of follow-up (f/u) EF assessment in these patients (pts) remains unclear.
Methods: We studied primary prevention ICD pts to assess the importance of long-term EF reassessment after ICD implant. We studied pts with a baseline EF≤35% ≤6 months prior to ICD implant and f/u EF 1-3 years post ICD without intervening left ventricular assist device (LVAD) or transplant. The study endpoint was a composite of time to death, LVAD, or transplant. We used multivariable Cox proportional hazard models with a 3 year post-implant landmark view; the EF closest to the 3 year mark was the f/u EF for analyses.
Results: Study patients (n=190) were mainly (73%) male and NYHA II (58%) with coronary disease (54%) and a severely reduced baseline EF (26±7%); >99% of pts were on ß-blockers and ACE/ARB. Median f/u (after landmark) was 931 days. Pts with a f/u EF ≥40% trended towards improved event free survival compared to those with a f/u EF <40% (HR 0.47, CI 0.22-1.02, p = 0.06); baseline EF (HR 0.93, CI 0.89-0.98, p = 0.003) was a strong independent predictor of outcome (Table). EF improvement of ≥10% (vs. <10%) was not significantly associated with the composite endpoint (Table).
Conclusions: Among primary prevention ICD pts, baseline EF is superior to long-term f/u EF at predicting risk for LVAD, transplant, or death. Further research will study the association between long-term f/u EF and ICD therapies.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-285
- 2017 American College of Cardiology Foundation