Changes in follow-up left ventricular ejection fraction associated with outcomes in primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy device recipients

Yiyi Zhang, Eliseo Guallar, Elena Blasco-Colmenares, Barbara Butcher, Sanaz Norgard, Victor Nauffal, Joseph E. Marine, Zayd Eldadah, Timm Dickfeld, Kenneth A. Ellenbogen, Gordon F. Tomaselli, Alan Cheng

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

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. Objectives This study sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks. 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. 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. 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.

Original languageEnglish (US)
Pages (from-to)524-531
Number of pages8
JournalJournal of the American College of Cardiology
Volume66
Issue number5
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Cardiac Resynchronization Therapy Devices
Implantable Defibrillators
Primary Prevention
Stroke Volume
Shock
Mortality
Sudden Cardiac Death
Tachycardia
Confidence Intervals
Proportional Hazards Models

Keywords

  • all-cause mortality
  • shock
  • sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Changes in follow-up left ventricular ejection fraction associated with outcomes in primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy device recipients. / Zhang, Yiyi; Guallar, Eliseo; Blasco-Colmenares, Elena; Butcher, Barbara; Norgard, Sanaz; Nauffal, Victor; Marine, Joseph E.; Eldadah, Zayd; Dickfeld, Timm; Ellenbogen, Kenneth A.; Tomaselli, Gordon F.; Cheng, Alan.

In: Journal of the American College of Cardiology, Vol. 66, No. 5, 01.01.2015, p. 524-531.

Research output: Contribution to journalArticle

Zhang, Yiyi ; Guallar, Eliseo ; Blasco-Colmenares, Elena ; Butcher, Barbara ; Norgard, Sanaz ; Nauffal, Victor ; Marine, Joseph E. ; Eldadah, Zayd ; Dickfeld, Timm ; Ellenbogen, Kenneth A. ; Tomaselli, Gordon F. ; Cheng, Alan. / Changes in follow-up left ventricular ejection fraction associated with outcomes in primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy device recipients. In: Journal of the American College of Cardiology. 2015 ; Vol. 66, No. 5. pp. 524-531.
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abstract = "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. Objectives This study sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks. 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. 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. 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.",
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T1 - Changes in follow-up left ventricular ejection fraction associated with outcomes in primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy device recipients

AU - Zhang, Yiyi

AU - Guallar, Eliseo

AU - Blasco-Colmenares, Elena

AU - Butcher, Barbara

AU - Norgard, Sanaz

AU - Nauffal, Victor

AU - Marine, Joseph E.

AU - Eldadah, Zayd

AU - Dickfeld, Timm

AU - Ellenbogen, Kenneth A.

AU - Tomaselli, Gordon F.

AU - Cheng, Alan

PY - 2015/1/1

Y1 - 2015/1/1

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. Objectives This study sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks. 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. 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. 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.

AB - 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. Objectives This study sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks. 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. 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. 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.

KW - all-cause mortality

KW - shock

KW - sudden cardiac death

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DO - 10.1016/j.jacc.2015.05.057

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JO - Journal of the American College of Cardiology

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