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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

Optimising the dichotomy limit for left ventricular ejection fraction in selecting patients for defibrillator therapy

Yee Guan Yap1, Trinh Duong, J Martin Bland

  • 1Department of Cardiological Sciences, St George's Hospital Medical School, London, UK. ygyap@aol.com

Heart (British Cardiac Society)
|January 24, 2007
PubMed

Insights

Determining the optimal left ventricular ejection fraction (LVEF) threshold for implantable cardioverter-defibrillator (ICD) therapy after myocardial infarction (MI) is complex. No single LVEF limit effectively identifies all patients who would benefit from ICDs for primary prevention.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Medical Devices

Background:

  • Patient selection for prophylactic implantable cardioverter-defibrilator (ICD) treatment post-myocardial infarction (MI) lacks definitive guidelines.
  • Left ventricular ejection fraction (LVEF) is a key factor, but its optimal threshold for ICD implantation remains debated.

Purpose of the Study:

  • To identify the optimal left ventricular ejection fraction (LVEF) dichotomy limit for implantable cardioverter-defibrilator (ICD) treatment in patients with a history of myocardial infarction (MI).
  • To evaluate the relationship between LVEF and mortality outcomes in post-MI patients to inform prophylactic ICD decision-making.

Main Methods:

  • Pooled data from placebo arms of four randomized trials involving 2828 patients with reduced left ventricular function after MI.
  • Statistical analysis to assess the predictive value of LVEF on all-cause, arrhythmic cardiac, and non-arrhythmic cardiac mortality over a 2-year follow-up period.

Main Results:

  • Left ventricular ejection fraction (LVEF) significantly predicted mortality; each 10% reduction in LVEF below 40% increased mortality risks.
  • A U-shaped relationship was observed between LVEF dichotomy limits and the number of patients needing treatment to prevent one arrhythmic death.
  • In patients with LVEF ≤10%, all deaths were non-arrhythmic, suggesting limited benefit from ICDs in this subgroup.

Conclusions:

  • No single LVEF threshold is entirely satisfactory for selecting patients for prophylactic ICD therapy due to a trade-off between sensitivity and predictive accuracy.
  • Implantable cardioverter-defibrilator (ICD) treatment showed no benefit for patients with LVEF ≤10% as they experienced non-arrhythmic deaths.
  • Reliance solely on LVEF is insufficient for optimal patient selection for primary prevention of cardiac arrest using ICDs.
Abstract

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