Prevalence and prognostic association of ventricular arrhythmia in non-ischaemic heart failure patients: results from the DANISH trial

EP Europace ◽  
2020 ◽  
Author(s):  
Rune Boas ◽  
Jens Jakob Thune ◽  
Steen Pehrson ◽  
Lars Køber ◽  
Jens C Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Ventricular Arrhythmia ◽  
Systolic Heart Failure ◽  
Sustained Ventricular Tachycardia ◽  
Icd Implantation ◽  
Premature Ventricular Contractions ◽  
High Burden ◽  
Heart Failure Patients ◽  
All Cause Mortality

Abstract Aims Improved risk stratification to identify non-ischaemic heart failure patients who will benefit from primary prophylactic implantable cardioverter-defibrillator (ICD) is needed. We examined the potential of ventricular arrhythmia to identify patients who could benefit from an ICD. Methods and results A total of 850 non-ischaemic systolic heart failure patients with left ventricle ≤35% and elevated N-terminal pro-brain natriuretic peptides had a 24-h Holter monitor recording performed. We examined present non-sustained ventricular tachycardia (NSVT), defined as ≥3 consecutive premature ventricular contractions (PVCs) with a rate of ≥100/min, and number of PVCs per hour stratified into low (<30) and high burden (≥30) groups. Outcome measures were overall mortality, sudden cardiac death (SCD), and cardiovascular death (CVD). In total, 193 patients died, 49 from SCD and 125 from CVD. Non-sustained ventricular tachycardia (365 patients) was significantly associated with increased all-cause mortality [hazard ratio (HR) 1.47; 95% confidence interval (CI) 1.07–2.03; P = 0.02] and to CVD (HR 1.89; CI 1.25–2.87; P = 0.003). High burden PVC (352 patients) was associated with increased all-cause mortality (HR1.38; CI 1.00–1.90; P = 0.046) and with CVD (HR 1.78; CI 1.19–2.66; P = 0.005). There was no statistically significant association with SCD for neither NSVT nor PVC. In interaction analyses, neither NSVT (P = 0.56) nor high burden of PVC (P = 0.97) was associated with survival benefit from ICD implantation. Conclusion Ventricular arrhythmia in non-ischaemic heart failure patients was associated with a worse prognosis but could not be used to stratify patients to ICD implantation.

Abstract 16124: Implantable Cardioverter Defibrillators in Patients With Hereditary Transthyretin Cardiac Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sreeram Yalamanchili ◽  
Matthew T Brown ◽  
Evan A Blank ◽  
Melissa A Lyle ◽  
Kunal N Bhatt
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Cardiac Amyloidosis ◽  
Clinical Decision Making ◽  
Systolic Heart Failure ◽  
Heart Association ◽  
High Rate ◽  
Implantable Cardioverter Defibrillators ◽  
Antitachycardia Pacing ◽  
Icd Implantation

Introduction: Implantable cardioverter defibrillator (ICD) implantation in patients with cardiac amyloidosis is controversial, with no clear guidelines for clinical decision-making.. The role of ICD implantation in hereditary Transthyretin Amyloid Cardiomyopathy (hATTR-CM) is unclear. We sought to establish the burden of ventricular arrhythmias and the outcomes of ICD implantation in a single center cohort of hATTR-CM patients. Methods: A total of 69 patients with a confirmed diagnosis of hATTR-CM from genetic testing, and technetium pyrophosphate (PYP) scanning, or endomyocardial biopsy underwent retrospective chart review for demographic, clinical, and arrhythmia data. Results: Seventy-four percent of the cohort was male, with a mean age at diagnosis of 68 (SD=18 years). Sixty-five patients (94.2%) patients were African-American; all of whom carried the Valine 122 Isoleucine mutation. Most had systolic heart failure (New York Heart Association Staging II [18, 26%] and III [40, 58.8%]); 37 (54%) patients had an LVEF ≤ 35%. Thirty-six (52.2%) patients had documented episodes of non-sustained ventricular tachycardia (NSVT), three (4.3%) with ventricular tachycardia (VT), and one (1.5%) with ventricular fibrillation (VF). A total of 15 (21.7%) patients had ICDs placed for prevention of sudden cardiac death in the setting of low LVEF (EF <35%). All recorded VT/VF episodes occurred in three patients with ICDs. Of these patients, one experienced two episodes of VT each successfully abated by antitachycardia pacing (ATP), another experienced a single episode of VT abated by ATP, while the final experienced VF with successful 36J shock as well as two episodes of VT each successfully treated with 36J shocks. No inappropriate ICD shocks were delivered, however, there were two instances of ATP for inappropriately detected atrial arrhythmias. Conclusions: In a cohort of patients with hATTR-CM, we observed a high incidence of NSVT, yet only 41% of patients with severe systolic heart failure had ICDs implanted. A high rate of successful defibrillation and no inappropriate ICD shocks were noted, suggesting that ICDs should be strongly considered, and may be underutilized, in patients with systolic heart failure and/or arrhythmias in the setting of hATTR-CM.

P2276Sudden cardiac death in non-ischemic systolic heart failure: do we only need LVEF to decide ICD implantation?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Mercier ◽  
E Hebbar ◽  
M Fertin ◽  
C Marquie ◽  
N Lamblin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Independent Predictor ◽  
Systolic Heart Failure ◽  
Cardiopulmonary Exercise Test ◽  
Sustained Ventricular Tachycardia ◽  
Cardiopulmonary Exercise ◽  
Qrs Duration ◽  
Composite Primary Endpoint

Abstract Background Implantable cardioverter defibrillator (ICD) is recommended in patients (pts) with non-ischaemic heart failure with left ventricular systolic dysfunction who receive optimal medical therapy (OMT) in order to prevent sudden cardiac death (SCD). However, the results of the DANISH study have recently shown the limits of these recommendations. It is therefore mandatory to reconsider the risk stratification of SCD in this population. Purpose The purpose of our study is to determine independent predictors of severe arrhythmic events (AE in pts with non-ischemic systolic heart failure. Methods Between January 1998 and December 2014, all consecutive outpatients with non-ischemic systolic heart failure, receiving OMT and without a history of significant arrhythmic events, were included. We performed to all the pts a clinical and biological evaluation, an echocardiography, a cardiopulmonary exercise test, a radionuclide angiography and a Holter-ECG. Follow-up was performed either by direct examination, by contact with the general practitioner or the cardiologist and by remote monitoring if available. The composite primary endpoint was the occurrence of SCD, recovered cardiac arrest, sustained ventricular tachycardia, or appropriate therapy by the ICD. Results We included 910 pts with a mean age of 53±12 years, 244 (27%) were women, LVEF was 36±10%. Most of the pts received renin-angiotensin blockers (97%) and betablockers (84%), 77% received diuretics and 41% spironolactone. During a median follow-up period of 6.33 [3.29–10.18] years, 160 (17.6%) pts presented the composite primary endpoint. The median time between the assessment and the occurrence of AE was 4.05 [1.68–7.85] years. The most powerful independent predictor of AE was non-sustained ventricular tachycardia (≥3 ectopic beats) (HR: 2.8 [1.66–4.72], p<0.0001). The other independent factors of AE were left atrial diameter (HR: 1.03 [1.01–1.06], p<0.0001); gender (HR: 0.71 [0.55–0.92], p=0.010); digoxin intake (HR: 1.63 [1.10–2.44], p=0.016); QRS duration (HR: 1.01 [1.00–1.01], p=0.022), sinus rhythm (HR: 0.70 [0.56–0.87], p=0.001). LVEF, as a quantitative parameter, was not an independent predictor of AE. However, LVEF dichotomized with a value of 35% was a modest predictor of AE (HR =1.38 [1.12–1.70], p=0.002). Neither the NYHA classification nor the parameters of the cardiopulmonary exercise test were independent factors of AE occurrence. Conclusion LVEF is not the most powerful predictor of severe arrhythmic events in outpatients with non-ischemic systolic heart failure receiving optimal medical therapy. New risk scores are required. We found that in addition to LVEF, gender, QRS duration, sinus rhythm, left atrial diameter and more particularly non-sustained ventricular tachycardia were independent predictors of AE. This score needs to be validated in an independent population. Acknowledgement/Funding None

U-shaped association of sphingosine-1-phosphate level with mortality in chronic systolic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Xue ◽  
Q Ma ◽  
S Chen ◽  
X Wang ◽  
A Ma
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Normal Range ◽  
Republic Of China ◽  
Heart Failure Patients ◽  
All Cause Mortality ◽  
Sphingosine 1 Phosphate ◽  
Chronic Systolic Heart Failure ◽  
Long Term Prognosis

Abstract Background The immunomodulatory molecule sphingosine-1-phosphate (S1P) has received attention in the cardiovascular field due to its significant cardioprotective effects, as revealed in animal studies. Until now, it has been unclear what is the normal range of S1P in chronic heart failure patients and whether it is related to long term prognosis. Purpose The purpose of our study was to identify the distribution characteristics of S1P in systolic heart failure patients and the prognostic value of S1P for long-term prognosis. Methods We recruited 210 chronic systolic heart failure patients from June 2014 to December 2015. Meanwhile 54 healthy people in the same area were selected as controls. Plasma S1P was measured by mass spectrometry. Patients were grouped according to the baseline S1P level quartiles, and restricted cubic spline plots described a U-shaped association between S1P and all cause death. Cox proportional hazard analysis was used to determine the relationship between category of S1P and all-cause death. Survival curves were using the Kaplan-Meier method and the log-rank test was used for comparison. Results Compared with the control group, the plasma S1P in chronic heart failure patients demonstrated a higher mean level (1.269 μmol/L vs 1.122 μmol/L, P=0.006) and a larger standard deviation (0.441 vs 0.316, P=0.022). After a follow-up period of 31.7±10.3 months, the second quartile (0.967–1.192μml/L) with largely normal S1P levels had the lowest all-cause mortality and either an increase (HR=3.87, 95% CI 1.504–9.960, P=0.005, adjusted HR=3.134, 95% CI 1.211–8.111, P=0.019) or a decrease (HR=3.271, 95% CI 1.277–8.381, P=0.014, adjusted HR=1.90, 95% CI 0.711–5.083, P=0.200) predicted a worse prognosis. Conclusions Plasma S1P levels in systolic heart failure patients are related to the long-term all-cause mortality with a U-shaped correlation. Through restoring abnormal levels to a normal range instead of simply up regulation or down regulation, S1P may have the potential to be a therapeutic target for reducing the risk of death in patients with heart failure in the future. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology of the People's Republic of China. Ministry of Finance of the People's Republic of China.

scholarly journals U-shaped association between plasma sphingosine-1-phosphate levels and mortality in patients with chronic systolic heart failure: A prospective cohort study.

2019 ◽  
Author(s):  
Yanbo Xue ◽  
Jiang Wei ◽  
Ma Qiong ◽  
Wang Xiqiang ◽  
Jia Pu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Control Group ◽  
Lipid Molecule ◽  
Heart Failure Patients ◽  
All Cause Mortality ◽  
Sphingosine 1 Phosphate ◽  
Chronic Systolic Heart Failure ◽  
Worse Prognosis

Abstract Background: The endogenous lipid molecule sphingosine-1-phosphate (S1P) has received attention in the cardiovascular field due to its significant cardioprotective effects, as revealed in animal studies. The purpose of our study was to identify the distribution characteristics of S1P in systolic heart failure patients and the prognostic value of S1P for long-term prognosis. Methods: We recruited 210 chronic systolic heart failure patients from June 2014 to December 2015. Meanwhile 54 healthy people in the same area were selected as controls. Plasma S1P was measured by liquid chromatography-tandem mass spectrometry. Patients were grouped according to the baseline S1P level quartiles, and restricted cubic spline plots described the association between S1P and all cause death. Cox proportional hazard analysis was used to determine the relationship between category of S1P and all-cause death. Results: Compared with the control group, the plasma S1P in chronic heart failure patients demonstrated a higher mean level (1.269 μmol/L vs 1.122 μmol/L, P=0.006) and a larger standard deviation (0.441 vs 0.316, P=0.022). After a follow-up period of 31.7 ± 10.3 months, the second quartile (0.967-1.192μml/L) with largely normal S1P levels had the lowest all-cause mortality and either an increase (HR=3.87, 95%CI 1.504-9.960, P=0.005) or a decrease (HR=3.271, 95%CI 1.277-8.381, P=0.014) predicted a worse prognosis. Being grouped into the quartile4 group after correction of other variables with prognostic values for all-cause mortality (adjusted HR=3.685 [1.391-9.763], p=0.009) still predicted a worse prognosis. The survival curves showed that S1P levels in the quartile1 and quartile4 groups significantly reduced the patient survival rate. Conclusions: Plasma S1P levels in systolic heart failure patients are related to the long-term all-cause mortality with a U-shaped correlation.

P4533Duration of heart failure and effect of defibrillator implantation in patients with non-ischemic systolic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M B Elming ◽  
A M Thoegersen ◽  
L Videbaek ◽  
N E Bruun ◽  
H Eiskjaer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Risk Indicators ◽  
Icd Implantation ◽  
Pump Failure ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Changes Over Time ◽  
The Relationship ◽  
Heart Foundation

Abstract Introduction Patients with non-ischemic systolic heart failure have increased risk of sudden cardiac death (SCD) and death from progressive pump failure. Whether the risk of SCD changes over time is unknown. We seek to investigate the relationship between duration of heart failure, mode of death, and effect of implantable cardioverter defibrillator (ICD) implantation. Methods We examined the risk of all-cause death and SCD according to the duration of heart failure among patients with non-ischemic systolic heart failure enrolled in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial. Patients were divided according to quartiles of heart failure duration (Q1 ≤8 months, Q2 9 ≤18 months, Q3 19 ≤65 months, Q4 ≥66 months). Results A total number of 1116 patients were included. Patients with the longest duration of heart failure were older, more often men, had more comorbidity, and more often received cardiac resynchronizing therapy device. Doubling of heart failure duration was an independent predictor of both all-cause mortality (HR 1.26 95% CI 1.17–1.37, p<0.0001), and SCD (HR 1.29 95% CI 1.11–1.49, p=0.0009). The proportion of deaths caused by SCD was not different between heart failure quartiles (p=0.91), and the effect of ICD implantation on all-cause mortality was not modified by the duration of heart failure (p=0.59). Duration of heart failure and death Conclusions Duration of heart failure predicted both all-cause mortality and risk of SCD independently of other risk indicators. However, the proportion of death caused by SCD did not change with longer duration of heart failure and the effect of ICD was not modified by the duration of heart failure. Acknowledgement/Funding The work was sponsored by The Danish Heart Foundation (Hjerteforeningen) and the Lundbeck Foundation (Lundbeckfonden). The DANISH trial was supported

Right ventricular free wall strain and effect of implantable defibrillator in non-ischemic heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.H Jensen ◽  
M.B Elming ◽  
R Risum ◽  
J Haarbo ◽  
B Philbert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Right Ventricular ◽  
Systolic Heart Failure ◽  
Right Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background Patients with left ventricular systolic heart failure have a significantly increased risk of all-cause mortality and sudden cardiac death. A cardiac magnetic resonance (CMR) sub-study of the Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators (ICDs) in Patients with Nonischemic Systolic Heart Failure on Mortality (DANISH) trial found that in patients who also had reduced right ventricular ejection fraction, ICD implantation significantly increased survival. Recent studies have found that right ventricular free wall strain (RV-FWS) assessed by echocardiography has a similar prognostic power as right ventricular ejection fraction assessed by CMR and RV-FWS determined by echocardiographic may be a more accessible imaging modality to identify patients more likely to benefit from ICD implantation. Purpose To investigate if echocardiographic RV-FWS is related to risk of all-cause death in patients with heart failure and left ventricular systolic dysfunction and whether RV-FWS can identify a sub-group of patients more likely to benefit from ICD implantation. Methods RV-FWS was measured in 343 patients with left ventricular systolic heart failure included in the DANISH trial at our hospital, who underwent an echocardiographic examination before randomization. Cox regression was used to assess the effects of RV-FWS and ICD implantation on all-cause mortality. Impaired RV-FWS was defined as RV-FWS &gt;−20% according to guidelines. Results Median RV-FWS was −19% (quartiles: −24% to −14%). Impaired RV-FWS was present in 186 (54%) patients, and 70 (20.4%) patients died. RV-FWS was related to all-cause mortality both univariably, hazard ratio (HR) 1.07 (95% confidence interval [CI], 1.03–1.11), P=0.001, and adjusted for age, gender, tricuspid annular plane systolic excursion and left ventricular ejection fraction, HR 1.06 (95% CI 1.01–1.10), P=0.009. There was a significant interaction between impaired RV-FWS and effect of ICD, P for interaction=0.045 and ICD implantation significantly reduced mortality in patients with impaired RV-FWS, HR 0.52 (95% CI 0.28–0.96), P=0.04, but not in patients with normal RV-FWS, HR 1.34 (95% CI 0.64–2.82), P=0.44. Conclusion RV-FWS was independently related to all-cause mortality and associated with effect of ICD implantation. With validation in larger studies, impaired RV-FWS may potentially become a candidate for selecting patients for ICD implantation. Impaired RVFWS and effect of ICD Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Danish Heart Foundation

scholarly journals U-shaped association between plasma sphingosine-1-phosphate levels and mortality in patients with chronic systolic heart failure: A prospective cohort study.

2020 ◽  
Author(s):  
Yanbo Xue ◽  
Jiang Wei ◽  
Ma Qiong ◽  
Wang Xiqiang ◽  
Jia Pu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Heart Failure ◽  
Cubic Spline ◽  
Lipid Molecule ◽  
Heart Failure Patients ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Sphingosine 1 Phosphate ◽  
Chronic Systolic Heart Failure

Abstract Background: The endogenous lipid molecule sphingosine-1-phosphate (S1P) has received attention in the cardiovascular field due to its significant cardioprotective effects, as revealed in animal studies. The purpose of our study was to identify the distribution characteristics of S1P in systolic heart failure patients and the prognostic value of S1P for long-term prognosis. Methods: We recruited 210 chronic systolic heart failure patients from June 2014 to December 2015. Meanwhile 54 healthy people in the same area were selected as controls. Plasma S1P was measured by liquid chromatography-tandem mass spectrometry. Patients were grouped according to the baseline S1P level quartiles, and restricted cubic spline plots described the association between S1P and all-cause death. Cox proportional hazard analysis was used to determine the relationship between category of S1P and all-cause death. Results: Compared with the control group, the plasma S1P in chronic heart failure patients demonstrated a higher mean level (1.269 μmol/L vs 1.122 μmol/L, P =0.006) and a larger standard deviation (0.441 vs 0.316, P =0.022). Based on multivariable Cox regression with restricted cubic spline analysis, a non-linear and U-shaped association between S1P levels and the risk of all-cause death was observed. After a follow-up period of 31.7 ± 10.3 months, the second quartile (0.967-1.192μml/L) with largely normal S1P levels had the lowest all-cause mortality and either an increase (adjusted HR=2.368, 95%CI 1.006-5.572, P =0.048) or a decrease (adjusted HR=0.041, 95%CI 0.002-0.808, P =0.036) predicted a worse prognosis.The survival curves showed that patients in the lowest quartile and highest quartile were at a higher risk of death. Conclusions: Plasma S1P levels in systolic heart failure patients are related to the long-term all-cause mortality with a U-shaped correlation.

The effect of implantable cardioverter-defibrillator in patients with diabetes and non-ischaemic systolic heart failure

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1203-1210 ◽  
Author(s):  
Rasmus Rørth ◽  
Jens Jakob Thune ◽  
Jens C Nielsen ◽  
Jens Haarbo ◽  
Lars Videbæk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sudden Cardiac Death ◽  
Treatment Effect ◽  
Cardiac Death ◽  
Systolic Heart Failure ◽  
Cardiovascular Death ◽  
Icd Implantation ◽  
Cardioverter Defibrillator ◽  
All Cause Mortality ◽  
Patients With Diabetes

Abstract Aims Implantable cardioverter-defibrillator (ICD) implantation reduce the risk of sudden cardiac death, but not all-cause death in patients with non-ischaemic systolic heart failure (HF). Whether co-existence of diabetes affects ICD treatment effects is unclear. Methods and results We examined the effect of ICD implantation on risk of all-cause death, cardiovascular death, and sudden cardiac death (SCD) according to diabetes status at baseline in the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischaemic Systolic Heart Failure on Mortality (DANISH) trial. Outcomes were analysed by use of cumulative incidence curves and Cox regressions models. Of the 1116 patients enrolled, 211 (19%) had diabetes at baseline. Patients with diabetes were more obese, had worse kidney function and more were in New York Heart Association Class III/IV. The risk of device infections and other complications in the ICD group was similar among patients with and without diabetes (6.1% vs. 4.6% P = 0.54). Irrespective of treatment group, diabetes was associated with higher risk of all-cause death, cardiovascular death, and SCD. The treatment effect of ICD in patients with diabetes vs. patients without diabetes was hazard ratio (HR) = 0.92 (0.57–1.50) vs. HR = 0.85 (0.63–1.13); Pinteraction = 0.60 for all-cause mortality, HR = 0.99 (0.58–1.70) vs. HR = 0.70 (0.48–1.01); Pinteraction = 0.25 for cardiovascular death, and HR = 0.81 (0.35–1.88) vs. HR = 0.40 (0.22–0.76); Pinteraction = 0.16 for sudden cardiac death. Conclusion Among patients with non-ischaemic systolic HF, diabetes was associated with higher incidence of all-cause mortality, primarily driven by cardiovascular mortality including SCD. Treatment effect of ICD therapy was not significantly modified by diabetes which might be due to lack of power.

P2627Diffuse coronary artery disease and effect of implantable cardioverter-defibrillators in patients with non-ischaemic systolic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Byrne ◽  
O Ahlehoff ◽  
F Pedersen ◽  
S Pehrson ◽  
J C Nielsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Atherosclerosis ◽  
Systolic Heart Failure ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Artery Disease ◽  
Cardioverter Defibrillators ◽  
Danish Study

Abstract Background Implantable defibrillators reduce mortality in patients with ischaemic heart failure. The recent Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients With Non-Ischaemic Systolic Heart Failure on Mortality (DANISH) found no overall effect on all-cause mortality with ICD implantation. Coronary artery disease (CAD) as the cause of heart failure had to be ruled out prior to inclusion into DANISH, but patients could have diffuse atherosclerosis, one- or two-vessel disease on the qualifying coronary angiogram if the investigator did not find that the degree of CAD could explain the severely reduced left ventricular ejection fraction. It is unknown if concomitant coronary atherosclerosis is related to outcome in patients with non-ischaemic cardiomyopathy and whether the effect of implanting an ICD is different in patients with non-ischaemic cardiomyopathy and coronary atherosclerosis. Purpose The aim of this study was to investigate the association between coronary atherosclerosis and all-cause mortality in patients with non-ischaemic systolic heart failure and the effect of ICD implantation in these patients. Methods Of the 1116 patients from the DANISH study, 838 patients with available coronary angiography data were included in this subgroup analysis. Patients were considered to have coronary atherosclerosis if the invasive cardiologist described diffuse atherosclerosis or coronary stenosis. We used cox regression to assess the relationship between coronary atherosclerosis and mortality and between ICD implantation and mortality in patients with and without coronary atherosclerosis. Data are presented as hazard ratios with 95% confidence intervals. Results Of the 838 patients, 266 (32%) had coronary atherosclerosis, 216 (81%) of whom were reported as having atherosclerosis without stenoses. Patients with coronary atherosclerosis were significantly older (median age 67 years vs 61 years), more often male (77% vs 70%) and had a higher prevalence of diabetes (30% vs 17%). In univariable analysis, coronary atherosclerosis was a significant predictor of all-cause mortality (HR, 1.41; 95% CI, 1.04–1.91; P=0.03). However, the association between coronary atherosclerosis and all-cause mortality disappeared when adjusting for age, gender and diabetes (HR 1.02, 0.75–1.41, P=0.88). Adjusted hazard ratios are shown in Figure 1. There was no association between ICD treatment and all-cause mortality in patients with or without coronary atherosclerosis (HR 0.94; 0.58–1.52; P=0.79 vs HR 0.82; 0.56–1.20; P=0.30), P for interaction=0.67. Figure 1 Conclusions In patients with non-ischaemic systolic heart failure, the concomitant presence of coronary atherosclerosis was associated with increased mortality. However, this association was not independent of other risk factors. ICD implantation was not associated with mortality risk in patients either with or without concomitant coronary atherosclerosis. Acknowledgement/Funding TrygFonden (Copenhagen, DK), Medtronic (US) and St. Jude Medical (US)

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