Increased mortality and ICD therapies in ischemic versus non-ischemic dilated cardiomyopathy patients with cardiac
Thomas Beiert1, Swanda Straesser1, Robert Malotki1
1Department of Internal Medicine II, University Hospital Bonn, Rheinische Friedrich-Wilhelms University, Bonn, Germany.
Insights
Patients with ischemic cardiomyopathy (ICM) receiving cardiac resynchronization therapy with a defibrillator (CRT-D) face higher mortality and defibrillator therapies compared to those with dilated cardiomyopathy (DCM). Long-term CRT-D outcomes differ significantly between ICM and DCM patients.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy with an implantable cardioverter defibrillator (CRT-D) is a common treatment for heart failure.
- Long-term data on arrhythmia, defibrillator therapies, and mortality following CRT-D implantation are limited and conflicting.
- This study investigates long-term outcomes in patients undergoing CRT-D implantation or upgrade.
Purpose of the Study:
- To characterize the incidence of ventricular arrhythmias and defibrillator therapies over several years post-CRT-D.
- To analyze long-term mortality rates in patients treated with CRT-D.
- To compare outcomes between patients with ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).
Main Methods:
- Eighty-eight patients with ICM or DCM receiving CRT-D replacement were analyzed.
- Incidence of non-sustained ventricular tachycardia (NSVT), defibrillator shocks, anti-tachycardia pacing (ATP), and mortality were assessed.
- Follow-up duration averaged 76.4 months.
Main Results:
- The incidence of appropriate defibrillator therapies (shock or ATP) was 46.6%, significantly higher in ICM (57.7%) versus DCM (30.6%) patients (p=0.017).
- ICM patients exhibited higher mortality (9-year cumulative all-cause mortality: 45.4% vs. 10.6% for DCM).
- Independent predictors of device intervention included NSVT, ICM, and reduced ejection fraction; predictors of mortality included ICM, chronic renal failure, peripheral artery disease, and COPD.
Conclusions:
- Long-term clinical courses for ICM and DCM patients treated with CRT-D diverge significantly.
- ICM patients experience a higher incidence of defibrillator therapies and increased mortality compared to DCM patients.
- These findings highlight the importance of considering underlying cardiomyopathy type in long-term CRT-D management.
Introduction:
Cardiac resynchronization therapy combined with an implantable cardioverter defibrillator (CRT-D) is widely applied in heart failure patients. Sufficient data on arrhythmia and defibrillator therapies during long-term follow-up of more than 4 years are lacking and data on mortality are conflicting. We aimed to characterize the occurrence of ventricular arrhythmia, respective defibrillator therapies and mortality for several years following CRT-D implantation or upgrade.
Material And Methods:
Eighty-eight patients with ischemic (ICM) or non-ischemic dilated cardiomyopathy (DCM) and at least one CRT-D replacement were included in this study and analyzed for incidence of non-sustained ventricular tachycardia (NSVT), defibrillator shocks, anti-tachycardia pacing (ATP) and mortality.
Results:
ICM was the underlying disease in 59%, DCM in 41% of patients. During a mean follow-up of 76.4 ±24.8 months the incidence of appropriate defibrillator therapies (shock or ATP) was 46.6% and was elevated in ICM compared to DCM patients (57.7% vs. 30.6%, respectively; p = 0.017). Kaplan-Meier analysis revealed significantly higher ICD therapy-free survival rates in DCM patients (p = 0.031). Left ventricular ejection fraction, NSVT per year and ICM (vs. DCM) were independent predictors of device intervention. The ICM patients showed increased mortality compared to DCM patients, with cumulative all-cause mortality at 9 years of follow-up of 45.4% and 10.6%, respectively. Chronic renal failure, peripheral artery disease and chronic obstructive pulmonary disease were independent predictors of mortality.
Conclusions:
The clinical course of patients with ICM and DCM treated with CRT-D differs significantly during long-term follow-up, with increased mortality and incidence of ICD therapies in ICM patients.
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