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Predictors of appropriate interventions and mortality in patients with implantable cardioverter-defibrillators
Aleksandra Winkler1, Agnieszka Jaguś-Jamioła2, Beata Uziębło-Życzkowska2
1Department of Cardiology and Internal Medicine, Military Institute of Medicine, Warsaw, Poland. awinkler@wim.mil.pl
Insights
Risk assessment for implantable cardioverter-defibrillators (ICDs) needs improvement. Secondary prevention implantation, resynchronization therapy, and mitral valve disease predict appropriate ICD therapy, while BMI, hemoglobin, LVEF, diabetes, and atrial diameter predict mortality.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Current risk stratification for implantable cardioverter-defibrillator (ICD) implantation, particularly for primary prevention, requires enhancement.
- Left ventricular ejection fraction (LVEF) alone lacks sufficient accuracy in identifying patients at high risk of sudden cardiac death.
Purpose of the Study:
- To identify predictors of appropriate ICD or cardiac resynchronization therapy defibrillator (CRT-D) therapy (both short- and long-term).
- To identify predictors of long-term mortality in patients receiving an ICD or CRT-D.
Main Methods:
- Retrospective analysis of data from 457 patients who received an ICD or CRT-D between 2011 and 2017.
- Multivariate Cox regression analysis was employed to identify significant predictors.
Main Results:
- Secondary prevention implantation, severe mitral valve disease, and prior myocardial infarction predicted appropriate interventions.
- In primary prevention, resynchronization therapy and severe mitral valve disease predicted appropriate interventions.
- Independent predictors of mortality included body mass index, hemoglobin levels, LVEF, diabetes, and left atrial diameter.
Conclusions:
- Secondary prevention implantation is a strong predictor of appropriate ICD/CRT-D therapy.
- Resynchronization therapy and severe mitral regurgitation are key predictors for primary prevention ICD therapy.
- Several factors, including BMI, hemoglobin, LVEF, diabetes, and left atrial diameter, independently predict mortality in ICD/CRT-D patients.
Introduction:
Additional risk assessment in patients with heart failure referred for implantable cardioverter‑defibrillator (ICD) implantation as primary prevention is needed. A reduction in left ventricular ejection fraction (LVEF) seems to lack sufficient sensitivity and specificity to be used for identification of patients at the highest risk of sudden cardiac death.
Objectives:
The aim of this study was to identify short- and long‑term predictors of appropriate implantable cardioverter‑defibrillator therapy as well as predictors of long‑term mortality in patients with an ICD or cardiac resynchronization therapy defibrillator (CRT‑D).
Patients And Methods:
In this retrospective study, data from 457 patients who had an ICD or CRT‑D implanted between 2011 and 2017 were analyzed.
Results:
During the median follow‑up of 31 months (interquartile range, 17-52 months), 153 patients died (33.9%) and 140 had appropriate interventions (31%). In a multivariate Cox regression analysis, implantation for secondary prevention (hazard ratio [HR], 2.49; P <0.001), severe mitral valve disease (HR, 2.17; P <0.001), and previous myocardial infarction (HR, 1.68; P = 0.009) were predictors of appropriate intervention. Resynchronization therapy (HR, 0.59; P = 0.025) and severe mitral valve disease (HR, 2.42; P <0.001) were predictors of appropriate intervention in primary prevention. Body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter were significant predictors of death.
Conclusions:
Implantation of ICD or CRT‑D as secondary prevention was a potent predictor of appropriate intervention, while resynchronization therapy and severe mitral regurgitation predicted ICD therapy in primary prevention. In patients with ICD or CRT-D, independent predictors of mortality included: body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter.
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