Efficacy of Implantable Cardioverter-Defibrillator Therapy in Patients With Nonischemic Cardiomyopathy

Narayanan, Mahesh Anantha; Vakil, Kairav; Reddy, Yogesh N.V.; Baskaran, Janani; Deshmukh, Abhishek; Benditt, David G.; Adabag, Selçuk

doi:10.1016/j.jacep.2017.02.006

Cited by 51 publications

(28 citation statements)

References 22 publications

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“…7 On the other hand, recently published metanalyses, including DANISH, showed undeniable reduction in mortality related with ICD implantation in patients with NICM. 8,9 All of the abovementioned investigations were based on comparisons between ICD and medical therapy. To the best of our knowledge, there is little evidence about long -term mortality after ICD implantation with regard to the etiology of HF from real -life settings and all -comers registries.…”

Section: Results Baseline Characteristicsmentioning

confidence: 99%

Long-term clinical outcomes after placement of an implantable cardioverter-defibrillator: does the etiology of heart failure matter?

et al. 2020

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BACKGROUND European and American guidelines for the placement of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy defibrillator (CRT D) in patients with heart failure (HF) remain unchanged despite controversy and ongoing debate on the etiology of HF. However, there are limited data on the long term follow up in patients who received primary defibrillator therapy with regard to ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM). The prognostic significance of the etiology of HF is not well established. AIMS The aim of the study was to assess the predictive value of the cause of HF. METHODS A total of 1073 patients with the first implantation of ICD / CRT D between January 2009 and December 2013 from the COMMIT HF (Contemporary Modalities In Treatment of Heart Failure) registry were selected for the study. Patients were divided into 2 groups depending on the etiology of HF: ischemic (n = 705; 65.7%) and nonischemic (n = 368; 34.3%). The primary endpoint was long term all cause mortality. RESULTS The median follow up was 60.5 months. The primary endpoint occurred more often in the ICM as compared with the NICM group (35.7% vs 26.6%; P = 0.008). A higher out of hospital mortality in patients with ICM tended to be statistically significant (15.5% vs 10.6; P = 0.05). The multivariate analysis revealed that, among others, an ischemic etiology of HF was an independent factor of long term mortality (hazard ratio, 1.43; 95% CI, 1.30-1.81; P = 0.003). Other independent predictors for mortality are: age older than 65 years, impaired left ventricular ejection fraction, chronic kidney disease, atrial fibrillation, diabetes mellitus. CONCLUSIONS In the real world population, significantly worse survival of patients with ICM in comparison with those with NICM is observed, and an ischemic etiology of HF is a strong independent predictor of mortality among individuals following the placement of ICD / CRTD. KEY WORDSheart failure, implantable cardioverter defibrillators, ischemic heart disease, nonischemic cardiomyopathy, prognostic factor

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Section: Results Baseline Characteristicsmentioning

confidence: 99%

Long-term clinical outcomes after placement of an implantable cardioverter-defibrillator: does the etiology of heart failure matter?

et al. 2020

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“…We included five databases for our search including PubMed, EMBASE, Scopus, Cochrane, and Web of Science for RCTs between January 2000 and October 2018 using the following search terms—“peripheral arterial disease,” “femoropopliteal disease,” “drug‐coated balloon,” “plain old balloon angioplasty,” and their combinations, limiting our language to English. The methodology has been validated and published in previous studies …”

Section: Methodsmentioning

confidence: 99%

Drug‐coated balloon versus plain old balloon angioplasty in femoropopliteal disease: An updated meta‐analysis of randomized controlled trials

Narayanan

Shah

Jelani

et al. 2019

Cathet Cardio Intervent

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Background Drug‐coated balloon (DCB) angioplasty has emerged as a mainstay of therapy for the treatment of peripheral arterial disease (PAD) involving the superficial femoral and popliteal arteries. We performed a meta‐analysis including all available randomized controlled trials (RCTs) to date which compare DCB to plain balloon angioplasty (POBA) in femoropopliteal disease (FPD). Methods Five databases were analyzed including EMBASE, PubMed, Cochrane, Scopus, and Web‐of‐Science from January 2000 to September 2018 for RCTs comparing DCB to POBA in patients with FPD. Heterogeneity was determined using Cochrane's Q‐statistics. Random effects model was used. Results Twenty‐two RCTs, including five trials of in‐stent restenosis (ISR) intervention, with 3,217 patients were included in the analysis. Mean follow‐up was approximately 21.6 ± 14.4 months. Overall, DCB use was associated with a 51% reduction in target vessel revascularization (TLR) when compared to POBA at follow‐up (relative risk [RR]: 0.49, 95% confidence interval [CI]: 0.40–0.61, P < 0.0001). Rates of TLR were 45% lower in the DCB group when compared to POBA in patients with ISR (RR: 0.55, 95% CI: 0.37–0.81, P = 0.002). DCB was associated with lower rates of binary stenosis, late lumen loss and higher primary safety endpoints. Major amputation and mortality were not different between DCB and POBA. Conclusions Use of DCBs is associated with improved vessel patency and a lower risk of TLR when compared to POBA in patients with FPD, especially in the setting of ISR. There was no difference in mortality between DCB and POBA in our meta‐analysis. Extended follow‐up of the available RCT data will be essential to analyze long‐term device‐related mortality.

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“…ICD therapy was beneficial only in patients younger than 68 years of age. Interestingly, data from recent post‐DANISH meta‐analyses reinforce the survival benefit of ICD therapy for primary prevention of SCD in NICM patients …”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes after prophylactic ICD and CRT‐D implantation in nonischemic patients: Analysis from a nationwide database of daily remote‐monitoring transmissions

Forleo¹,

Solimene²,

Pisanò

et al. 2019

Cardiovasc electrophysiol

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Introduction: Clinical trials did not provide conclusive evidence concerning the benefit of prophylactic implantable cardioverter‐defibrillators (ICDs) in patients with severe nonischemic cardiomyopathy (NICM). We aimed to compare incidence of appropriate sustained ventricular arrhythmia (SVA) and device therapy in ischemic cardiomyopathy (ICM) vs NICM ICD and/or cardiac resynchronization therapy (CRT‐D) patients. Methods and Results: We analyzed remote‐monitoring data from devices of the Home Monitoring Expert Alliance network. SVA recordings were adjudicated by three independent electrophysiologists. Our cohort included 1,946 patients who received either an ICD (55%) or a CRT‐D (45%) for primary prevention of sudden cardiac death. Median (interquartile range) age was 70 (62‐77) years, 81% were male, and 52% were in the ICM group. Patients were remotely monitored for a maximum follow‐up of 5 years. The 5‐year product‐limit estimate of SVA incidence in patients with an ICD was 47.3% (95% confidence interval [CI], 41.0%‐53.9%) in the ICM group and 44.7% (36.9%‐53.3%) in the NICM group. In patients with a CRT‐D, SVA incidence was 45.7% (37.3%‐55.0%) in ICM patients and 49.2% (40.4%‐58.7%) in NICM patients. The adjusted hazard ratio for SVA in the ICM vs NICM group was 0.96 (95% CI: 0.70‐1.30, P = .77) in ICD patients and 0.85 (95% CI: 0.61‐1.18, P = .34) in CRT‐D patients. SVAs triggered appropriate device therapies with similar incidence in all groups. Conclusion: In a large cohort of remotely monitored ICD and CRT‐D recipients, SVA incidence did not significantly differ in ICM and NICM patients.

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Efficacy of Implantable Cardioverter-Defibrillator Therapy in Patients With Nonischemic Cardiomyopathy

Cited by 51 publications

References 22 publications

Long-term clinical outcomes after placement of an implantable cardioverter-defibrillator: does the etiology of heart failure matter?

Long-term clinical outcomes after placement of an implantable cardioverter-defibrillator: does the etiology of heart failure matter?

Drug‐coated balloon versus plain old balloon angioplasty in femoropopliteal disease: An updated meta‐analysis of randomized controlled trials

Long‐term outcomes after prophylactic ICD and CRT‐D implantation in nonischemic patients: Analysis from a nationwide database of daily remote‐monitoring transmissions

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