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



      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).


      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.


      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.


      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.


      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


      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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