TY  - BOOK
AU  - Eldadah, Zayd A
TI  - Changes in Follow-Up Left Ventricular Ejection Fraction Associated With Outcomes in Primary Prevention Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Device Recipients
SN  - 0735-1097
KW  - *Cardiac Resynchronization Therapy
KW  - *Death, Sudden, Cardiac
KW  - *Electric Countershock
KW  - *Heart Failure
KW  - *Ventricular Dysfunction, Left
KW  - Aged
KW  - Cardiac Resynchronization Therapy/mt [Methods]
KW  - Cardiac Resynchronization Therapy/sn [Statistics & Numerical Data]
KW  - Cohort Studies
KW  - Death, Sudden, Cardiac/ep [Epidemiology]
KW  - Death, Sudden, Cardiac/et [Etiology]
KW  - Death, Sudden, Cardiac/pc [Prevention & Control]
KW  - Defibrillators, Implantable
KW  - Electric Countershock/is [Instrumentation]
KW  - Electric Countershock/mt [Methods]
KW  - Female
KW  - Heart Failure/co [Complications]
KW  - Heart Failure/th [Therapy]
KW  - Humans
KW  - Incidence
KW  - Male
KW  - Middle Aged
KW  - Proportional Hazards Models
KW  - Prospective Studies
KW  - Risk Assessment
KW  - Severity of Illness Index
KW  - Stroke Volume
KW  - United States/ep [Epidemiology]
KW  - Ventricular Dysfunction, Left/di [Diagnosis]
KW  - Ventricular Dysfunction, Left/et [Etiology]
KW  - Ventricular Dysfunction, Left/mo [Mortality]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
KW  - Multicenter Study
KW  - Research Support, N.I.H., Extramural
KW  - Research Support, Non-U.S. Gov't
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
N2  - BACKGROUND: Heart failure patients with primary prevention implantable cardioverter-defibrillators (ICD) may experience an improvement in left ventricular ejection fraction (LVEF) over time. However, it is unclear how LVEF improvement affects subsequent risk for mortality and sudden cardiac death; CONCLUSIONS: Among primary prevention ICD patients, 40.0% had an improved LVEF during follow-up and 25% had LVEF improved to >35%. changes in LVEF were inversely associated with all-cause mortality and appropriate shocks for ventricular tachyarrhythmias. In patients whose follow-up LVEF improved to >35%, the risk of an appropriate shock remained but was markedly decreased.Copyright � 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved; METHODS: We conducted a prospective cohort study of 538 patients with repeated LVEF assessments after ICD implantation for primary prevention of sudden cardiac death. The primary endpoint was appropriate ICD shock defined as a shock for ventricular tachyarrhythmias. The secondary endpoint was all-cause mortality; OBJECTIVES: This study sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks; RESULTS: Over a mean follow-up of 4.9 years, LVEF decreased in 13.0%, improved in 40.0%, and was unchanged in 47.0% of the patients. In the multivariate Cox models comparing patients with an improved LVEF with those with an unchanged LVEF, the hazard ratios were 0.33 (95% confidence interval: 0.18 to 0.59) for mortality and 0.29 (95% confidence interval: 0.11 to 0.78) for appropriate shock. During follow-up, 25% of patients showed an improvement in LVEF to >35% and their risk of appropriate shock decreased but was not eliminated
UR  - http://dx.doi.org/10.1016/j.jacc.2015.05.057
ER  -