Impact of Improved Left Ventricular Systolic Function on the Recurrence of Ventricular Arrhythmia in Heart Failure Patients With an Implantable Cardioverter‐Defibrillator

Kim, Minsu; Kim, Jun; Lee, Ji Hyun; Hwang, You Mi; Kim, Minseok; Nam, Gi‐Byoung; Choi, Kee–Joon; Kim, Jae‐Joong; Kim, F.H.R.S. You-Ho

doi:10.1111/jce.13037

Cited by 9 publications

(6 citation statements)

References 34 publications

(92 reference statements)

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“…Twenty-four eligible observational studies were included in the meta-analysis. 5,[8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] No eligible randomized trials were identified. The search process and outputs are shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…In 17 studies 5,9–13,16–19,21-23,26-27,29,31 reporting data on all-cause mortality, there were more deaths among HFpREF patients (1311/7497, 17.5%) than among HFIEF patients (134/2281, 5.8%). This corresponded to a significantly lower risk of mortality in HFIEF patients, compared with HFpREF patients, with an estimated RR of 0.34 (CI 0.28–0.41, p < 0.001) (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…13 Two studies included patients exclusively with non-ischaemic cardiomyopathy, 9,12 while the other 22 studies included patients with cardiomyopathies of miscellaneous origins. Nine studies 5,9,10,12,17,18,21,25,31 included patients receiving predominantly drug therapy, four studies 8,13,19,23 included patients with implanted primary prophylactic ICD, three studies 16,24,27 included patients with predominantly cardiac resynchronization therapy pacemaker and eight studies 11,15,20,22,26,[28][29][30] included patients with CRT-D. The definition of baseline cutoff value of LVEF% varied widely between studies (Supplementary eTable 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Adjusted hazard ratios were directly available from seven studies 5,11,13,19,23,25,31 comparing HFIEF with HFpREF. Meta-analysis showed a significantly lower risk of mortality with a combined hazard ratio of 0.27 (CI 0.18-0.35, p < 0.001) (Supplementary eFigure 1).…”

Section: Meta-analysis Of Risk Of All-cause Mortalitymentioning

confidence: 99%

“…Data from 13 studies 8,11,13,15,16,19,20,23,24,26,[28][29][30] were eligible for a meta-analysis of the risk of appropriate shocks. There were significantly fewer events of appropriate ICD shocks in patients with HFIEF (146/1339, 10.9%) compared with patients with HFpREF (401/ 1569, 25.5%), with a RR of 0.58 (CI 0.46-0.74, p < 0.001).…”

Section: Meta-analysis Of Appropriate Icd Shocksmentioning

confidence: 99%

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Characteristics and prognosis of heart failure with improved compared with persistently reduced ejection fraction: A systematic review and meta-analyses

Jørgensen

Andersson

Vasan

et al. 2018

Eur J Prev Cardiolog

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Aims We assessed the clinical characteristics and prognosis of chronic heart failure patients with improved ejection fraction (HFIEF) compared with persistently reduced ejection fraction (HFpREF) after evidence-based therapy. Methods and results We performed a meta-analysis including 24 eligible observational studies comparing 2663 HFIEF (≥5% left ventricular ejection fraction (LVEF) improvement) versus 8355 HFpREF patients who received recommended drug therapy, cardiac resynchronization therapy and/or intracardiac defibrillator. LVEF was assessed at baseline and reassessed after 19 ± 19 months. The primary endpoints were all-cause mortality and appropriate shocks. The mean duration of follow-up was 39 ± 12 months. Among HFIEF patients, LVEF improved 16.3 percentage points (95% confidence interval 15.9-16.6, p < 0.0001). Compared with HFpREF patients, HFIEF patients had a comparable mean age (60.9 years vs. 62.4 years, p = 0.11), were more often women (33% vs. 25%), had a higher prevalence of non-ischaemic heart failure (58% vs. 53%), less diabetes (27% vs. 28%), higher systolic blood pressure (127.5 ± 9 vs. 122 ± 12 mmHg) and lower left ventricle end-diastolic diameter (64.1 ± 3.7 vs. 67.4 ± 4.9 mmHg), all p-values < 0.05. Absolute risk of all-cause mortality was lower in HFIEF (5.8%) compared with HFpREF (17.5%) with a risk ratio of 0.34 (95% confidence interval 0.28-0.41), p < 0.001. Risk of appropriate shocks was significantly lower in HFIEF versus HFpREF (risk ratio 0.58 (95% confidence interval 0.46-0.74), p < 0.001). Conclusion In heart failure patients, we identified several baseline characteristics in favour of an improved LVEF, in response to evidence based therapy. Patients with improved LVEF had significantly lower risks of mortality and appropriate shocks compared with patients with persistently reduced LVEF.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Meta-analysis Of Risk Of All-cause Mortalitymentioning

confidence: 99%

Section: Meta-analysis Of Appropriate Icd Shocksmentioning

confidence: 99%

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Characteristics and prognosis of heart failure with improved compared with persistently reduced ejection fraction: A systematic review and meta-analyses

Jørgensen

Andersson

Vasan

et al. 2018

Eur J Prev Cardiolog

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Shocks after implantable cardioverter-defibrillator implantation in idiopathic cardiomyopathy patients: a myocardial biopsy study

et al. 2017

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Prediction of follow-up shock is crucial to stratify patients with dilated cardiomyopathy (DCM) requiring implantable cardioverter defibrillator (ICD). The objective of the article is to assess the predictive value of endo-myocardial biopsy (EMB) towards ICD shock and follow-up mortality. A series of patients with DCM scheduled for ICD implantation underwent EMB to further determine the genesis of DCM. Presence of fibrosis and inflammation was documented and related to outcomes. A total of 240 patients were referred for ICD as primary (56%) and secondary (44%) prophylaxis. EMB showed myocardial fibrosis in 55.4%, inflammation in 55.7%, and viral genomic material in 60%. Median follow-up was 39 months (1-209). Appropriate and inappropriate shocks occurred in 29.2 and 20.4%. At logistic regression, determinants of appropriate shock were ICD indication for secondary prophylaxis (direct relationship: p = 0.009, OR 3.4, CI 1.3-8.8) and presence of inflammation at EMB (inverse relationship: p = 0.04, OR 0.4, CI 0.1-0.9). Moreover, the sole determinant of inappropriate shock was age at implant (inverse relationship: p = 0.003, OR = 0.9, CI 0.90-0.98). Overall mean estimated survival was 168 months and 5-year survival was 83%. Degree of improvement in LVEF% was the sole determinant of follow-up mortality (inverse relationship p = 0.02; HR = 0.9; CI 0.88-0.99). Present selection criteria for ICDs implant rely mainly on LVEF% that lacks sensitivity and specificity. EMB can identify the substrate of increased or reduced life-threatening arrhythmias. Presence of inflammation is a positive prognostic factor for reduced arrhythmogenic risk, independently by the ICD implantation indication.

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Prognostic impact of left ventricular ejection fraction in patients with electrical storm

Müller¹,

Behnes²,

Ellguth³

et al. 2019

J Interv Card Electrophysiol

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Impact of Improved Left Ventricular Systolic Function on the Recurrence of Ventricular Arrhythmia in Heart Failure Patients With an Implantable Cardioverter‐Defibrillator

Abstract: Overall survival was better and the recurrence of ventricular arrhythmia was lower in the patients with improved LV function.

Cited by 9 publications

References 34 publications

Characteristics and prognosis of heart failure with improved compared with persistently reduced ejection fraction: A systematic review and meta-analyses

Characteristics and prognosis of heart failure with improved compared with persistently reduced ejection fraction: A systematic review and meta-analyses

Shocks after implantable cardioverter-defibrillator implantation in idiopathic cardiomyopathy patients: a myocardial biopsy study

Prognostic impact of left ventricular ejection fraction in patients with electrical storm

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