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Research Article|Articles in Press

Imaging Modality for Left Ventricular Ejection Fraction Estimation and Effect of Implantable Cardioverter Defibrillator on Mortality in Patients with Heart Failure

      Abstract

      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).

      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.

      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.

      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.

      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.

      Key Words

      Abbreviations:

      ICD (implantable cardioverter-defibrillator), HFrEF (heart failure and reduced ejection fraction), LVEF (left ventricular ejection fraction), 2DE (2-dimensional echocardiography), MUGA (multi-gated acquisition radionuclide ventriculography), SCD-HeFT (Sudden Cardiac Death in Heart Failure trial), SCD (sudden cardiac death), NHLBI (National Heart Lung and Blood Institute), CMR (cardiac magnetic resonance imaging)
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      References

        • Carson P
        • Anand I
        • O’Connor C
        • et al.
        Mode of Death in Advanced Heart Failure: The Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) Trial.
        J Am Coll Cardiol. 2005; 46: 2329-2334
        • Chugh SS
        Disrupting the approach to sudden cardiac death: From vulnerable ejection fraction to vulnerable patient.
        Circulation. 2018; 137: 7-9
      1. Priori SG, Blomströ M-Lundqvist C. ESC GUIDELINES 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC).

        • Al-Khatib SM
        • Stevenson WG
        • Ackerman MJ
        • et al.
        2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
        Circulation. 2018; 138: e272-e391
      2. Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an Implantable Cardioverter-Defibrillator for Congestive Heart Failure. 2005.

        • Packer DL
        • Prutkin JM
        • Hellkamp AS
        • et al.
        Impact of Implantable Cardioverter-Defibrillator, Amiodarone, and Placebo on the Mode of Death in Stable Patients With Heart Failure Analysis From the Sudden Cardiac Death in Heart Failure Trial.
        Circulation. 2009; 120: 2170-2176
        • Wu KC
        • Calkins H
        Powerlessness of a Number: Why Left Ventricular Ejection Fraction Matters Less for Sudden Cardiac Death Risk Assessment.
        Circ Cardiovasc Imaging. 2016; 9: 212-217
        • Lane C
        • Dorian P
        • Ghosh N
        • et al.
        Limitations in the current screening practice of assessing left ventricular ejection fraction for a primary prophylactic implantable defibrillator in southern Ontario.
        Can J Cardiol. 2010; 26: e118
        • Dhir V
        • Yan AT
        • Nisenbaum R
        • et al.
        Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: a prospective observational study.
        Int J Cardiovasc Imaging. 2019; 35: 2085-2093
        • De Haan S
        • De Boer K
        • Commandeur J
        • Beek AM
        • Van Rossum AC
        • Allaart CP
        Assessment of left ventricular ejection fraction in patients eligible for ICD therapy: Discrepancy between cardiac magnetic resonance imaging and 2D echocardiography.
        Neth Heart J. 2014; 22: 449-455
      3. Aly MFA, Kleijn SA, Menken-Negroiu · R F, Robbers · L F, Beek · A M, Kamp · O. Three-dimensional speckle tracking echocardiography and cardiac magnetic resonance for left ventricular chamber quantification and identification of myocardial transmural scar. Netherlands Hear J. 2016;

      4. Keil L, Chevalier C, Kirchhof P, et al. Molecular Sciences CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter-Defibrillator in Non-Ischemic Cardiomyopathy. 2021; Int J Mol Sci. 2021;22.

      5. Weng Z, Yao J, Chan RH, et al. Prognostic Value of LGE-CMR in HCM A Meta-Analysis. 2016; JACC Cardiovasc Imaging. 2016;9:1392-1402.