Imaging Modality for Left Ventricular Ejection Fraction Estimation and Effect of Implantable Cardioverter Defibrillator on Mortality in Patients with Heart Failure.
Citation: Heart Rhythm. 2023 Mar 10PMID: 36907232Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Cardiovascular Disease Fellowship | Internal Medicine Residency | MedStar Georgetown University Hospital/MedStar Washington Hospital CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2023Local holdings: Available online through MWHC library: 2004 - presentISSN:- 1547-5271
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Journal Article | MedStar Authors Catalog | Article | Available |
Available online through MWHC library: 2004 - present
BACKGROUND: Implantable cardioverter-defibrillators (ICD) improve outcomes in patients with heart failure (HF) with left ventricular ejection fraction (LVEF) <=35%. Less is known whether outcomes varied between the two non-invasive imaging modalities used to estimate LVEF, the 2-dimensional echocardiography (2DE) and multi-gated acquisition radionuclide ventriculography (MUGA), which use different principles (geometric vs. count-based, respectively).
CONCLUSIONS: We found no evidence that in patients with HF and LVEF <=35%, the effect of ICD on mortality varied by the non-invasive imaging method used to measure LVEF. Copyright © 2023. Published by Elsevier Inc.
METHODS: Of the 2521 patients with HF with LVEF <=35% in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), 1676 were randomized to either placebo or ICD, of whom 1386 had LVEF measured by 2DE (n=971) or MUGA (n=415). Hazard ratios (HRs) and 97.5% CIs for mortality associated with ICD use were estimated overall, checking for interaction, and within the two imaging subgroups.
OBJECTIVES: To examine if the effect of ICD on mortality in patients with HF and LVEF <=35% varied based on LVEF measured by 2DE or MUGA.
RESULTS: Among the 1386 patients in the current analysis, all-cause mortality occurred in 23.1% (160/692) and 29.7% (206/694) of patients randomized to ICD or placebo, respectively (HR, 0.77; 97.5% CI, 0.61-0.97), which is consistent with that in 1676 patients in the original report. HRs (97.5% CIs) for all-cause mortality in the 2DE and MUGA subgroups were 0.79 (0.60-1.04) and 0.72 (0.46-1.11), respectively (p for interaction, 0.693). Similar associations were observed for cardiac and arrhythmic mortalities.
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