Trajectory of left ventricular ejection fraction among individuals eligible for implantable...

Examine the trajectory of left ventricular ejection fraction (EF) among patients eligible for implantable cardioverter-defibrillator (ICD) therapy.

EF is the cornerstone criterion for ICD therapy, but the risk of sudden cardiac death remains after an improvement in EF.

We examined the trajectory of EF among 1178 participants of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) who had three or more assessments of EF, at least 90 days apart. A follow-up EF > 35% or >10% absolute increase in EF from baseline were examined as the criteria for EF improvement.

At first follow-up, 381 (32%) patients had an improvement of EF to >35%. However, EF had returned back to ≤35% in 109 (27%) of these patients at second follow-up. Similarly, 446 (38%) patients experienced a >10% improvement in EF at first follow-up, but 109 (24%) of these had a subsequent >10% decrease in EF at the second follow-up. Of the 32 patients with normalized EF (≥55%) at first follow-up, 18 (56%) had a subsequent >10% decrease in EF. The fluctuation in EF was present in both ischemic and nonischemic cardiomyopathy but a higher proportion of patients with nonischemic cardiomyopathy had an improvement in EF to >35% at first follow-up compared to those with ischemic cardiomyopathy (38% vs. 27%, p = < .0001).

There is substantial fluctuation of EF among patients who are eligible for ICD therapy.