Imaging modality for left ventricular ejection fraction estimation and effect of implantable cardioverter-defibrillator on mortality in patients with heart failure.

MedStar author(s):
Citation: Heart Rhythm. 2023 Mar 11PMID: 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 INDEXED | Year: 2023Local holdings: Available online through MWHC library: 2004 - presentISSN:
  • 1547-5271
Name of journal: Heart rhythmAbstract: BACKGROUND: Implantable cardioverter-defibrillators (ICDs) improve outcomes in patients with heart failure (HF) with left ventricular ejection fraction (LVEF) <=35%. Less is known about whether outcomes varied between the 2 noninvasive imaging modalities used to estimate LVEF-2-dimensional echocardiography (2DE) and multigated acquisition radionuclide ventriculography (MUGA)-which use different principles (geometric vs count-based, respectively).CONCLUSION: We found no evidence that in patients with HF and LVEF <=35%, the effect of ICD on mortality varied by the noninvasive imaging method used to measure LVEF. Copyright � 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.METHODS: Of the 2521 patients with HF with LVEF <=35% in the Sudden Cardiac Death in Heart Failure Trial, 1676 (66%) were randomized to either placebo or ICD, of whom 1386 (83%) had LVEF measured by 2DE (n = 971) or MUGA (n = 415). Hazard ratios (HRs) and 97.5% confidence intervals (CIs) for mortality associated with ICD were estimated overall, checking for interaction, and within the 2 imaging subgroups.OBJECTIVE: The purpose of this study was to examine whether the effect of ICD on mortality in patients with HF and LVEF <=35% varied on the basis of LVEF measured by 2DE or MUGA.RESULTS: Of the 1386 patients in the present analysis, all-cause mortality occurred in 23.1% (160 of 692) and 29.7% (206 of 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 = .693 for interaction). Similar associations were observed for cardiac and arrhythmic mortalities.All authors: Ahmed A, Deedwania P, Fletcher RD, Fonarow GC, Greenberg MD, Iskandrian AE, Kumar S, Lam PH, Moore HJ, Nanda NC, Raman VK, Singh S, Smith AFiscal year: FY2023Digital Object Identifier: Date added to catalog: 2023-06-28
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Journal Article MedStar Authors Catalog Article 36907232 Available 36907232

Available online through MWHC library: 2004 - present

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) improve outcomes in patients with heart failure (HF) with left ventricular ejection fraction (LVEF) <=35%. Less is known about whether outcomes varied between the 2 noninvasive imaging modalities used to estimate LVEF-2-dimensional echocardiography (2DE) and multigated acquisition radionuclide ventriculography (MUGA)-which use different principles (geometric vs count-based, respectively).

CONCLUSION: We found no evidence that in patients with HF and LVEF <=35%, the effect of ICD on mortality varied by the noninvasive imaging method used to measure LVEF. Copyright � 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

METHODS: Of the 2521 patients with HF with LVEF <=35% in the Sudden Cardiac Death in Heart Failure Trial, 1676 (66%) were randomized to either placebo or ICD, of whom 1386 (83%) had LVEF measured by 2DE (n = 971) or MUGA (n = 415). Hazard ratios (HRs) and 97.5% confidence intervals (CIs) for mortality associated with ICD were estimated overall, checking for interaction, and within the 2 imaging subgroups.

OBJECTIVE: The purpose of this study was to examine whether the effect of ICD on mortality in patients with HF and LVEF <=35% varied on the basis of LVEF measured by 2DE or MUGA.

RESULTS: Of the 1386 patients in the present analysis, all-cause mortality occurred in 23.1% (160 of 692) and 29.7% (206 of 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 = .693 for interaction). Similar associations were observed for cardiac and arrhythmic mortalities.

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