scholarly journals Comparison of ventricular tachyarrhythmia recurrence between ischemic cardiomyopathy and dilated cardiomyopathy: a retrospective study

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5312 ◽  
Author(s):  
Chih-Yuan Fang ◽  
Huang-Chung Chen ◽  
Yung-Lung Chen ◽  
Tzu-Hsien Tsai ◽  
Kuo-Li Pan ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Dilated Cardiomyopathy ◽  
Cardiovascular Mortality ◽  
Ischemic Cardiomyopathy ◽  
Ventricular Tachyarrhythmia ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

BackgroundThe use of an implantable cardioverter-defibrillator (ICD) has been established as an effective secondary prevention strategy for ventricular tachycardia (VT)/ventricular fibrillation (VF). However, few reports discuss the difference in clinical predictors for recurrent VT/VF between patients with ischemic cardiomyopathy (ICM) and patients with dilated cardiomyopathy (DCM).MethodsFrom May 2004 to December 2015, 132 consecutive patients who had ICM (n= 94) or DCM (n= 38) and had received ICD implantation for secondary prevention were enrolled in this study. All anti-tachycardia events during follow-up were validated. The clinical characteristics and echocardiographic parameters were obtained for comparison. The incidence of recurrence of VT/VF, cardiovascular mortality, all-cause mortality, the change of left ventricular ejection fraction (LVEF) and LV volume were analyzed.ResultsAt a mean follow-up of 3.62 ± 2.93 years, 34 patients (36.2%) in the ICM group and 22 patients (57.9%) in the DCM group had a recurrence of VT/VF episodes (p= 0.032). The DCM group had a lower LVEF (p= 0.019), a larger LV end-diastolic volume (LVEDV) (p= 0.001), a higher prevalence of LVEDV >158 mL (p= 0.010), and a larger LV end-systolic volume (p= 0.010) than the ICM group. LVEDV >158 mL and no use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker were independent predictors of recurrences of VT/VF in ICM patients but not in DCM patients. There were no difference in cardiovascular mortality and all-cause mortality between the ICM and DCM patients.ConclusionThe DCM patients had a higher recurrence rate of VT/VF than did the ICM patients during long-term follow-up. An enlarged LV is an independent predictor of the recurrence of VT/VF in ICM patients receiving ICD for secondary prevention.

scholarly journals P1428 Mortality in non-ischemic cardiomyopathy is low and close to the general population

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Melichova ◽  
T M Nguyen ◽  
I M Salte ◽  
L G Klaebo ◽  
B Sjoli ◽  
...  
Keyword(s):  
Primary Prevention ◽  
General Population ◽  
Ischemic Cardiomyopathy ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality ◽  
Annual Mortality

Abstract Funding Acknowledgements South Eastern Norway regional health authority Background Patients with non-ischemic dilated cardiomyopathy (NDCM) have lower mortality compared to patients with ischemic cardiomyopathy (ICM). Recent reports suggest less benefit of a primary prophylactic implantable cardioverter defibrillator (ICD) in NDCM. Purpose We aimed to investigate mortality rate and appropriate ICD therapy in a consecutive cohort of patients with NDCM and ICM. Methods In this prospective multi-center study, we consecutively included NDCM and ICM patients with left ventricular ejection fraction (LVEF) < 40% from July 2014 to January 2018. ICM or NDCM classification was based on coronary angiography. Echocardiography was performed at inclusion and LVEF and global longitudinal strain (GLS) were assessed. All-cause mortality and primary prevention ICD therapies were recorded during follow-up. Results We included 290 patients (67 ± 13 years old, 74% males), 207 with ICM and 83 with NDCM. At inclusion LVEF was 31 ± 6% and GLS -10.5 ± -3.3%. Patients with ICM were older (68 ± 12 years vs. 63 ± 15 years, p < 0.01), had better LVEF (32 ± 6% vs. 28 ± 7%, p < 0.01), and shorter QRS duration (106 ± 23 ms vs. 122 ± 28 ms, p < 0.01). A primary prevention ICD was implanted in 18 (9%) ICM patients and in 21 (25%) NDCM patients (p < 0.001). During 22 ±12 months follow up, all-cause mortality was 27 (9%) in the entire population. In patients with ICM 1/18 (6%) received appropriate shock from their primary prevention ICD compared to 3/21 (14%) NDCM patients. Mortality was more frequent in ICM; 26/207 (13%) compared to 1/83 (1.2%) in NDCM (Log rank p < 0.01). All-cause mortality or appropriate ICD shock was more frequent in ICM compared to NDCM (27 (13%) vs. 4 (5%) log rank p = 0.02) (Figure). Assuming the arrhythmias treated by the ICD shocks would have been lethal, annual mortality of 2.5% in the NDCM population was only slightly higher compared to the age matched general population (1% annual mortality) (blue line). Conclusion Patients with NDCM had better survival, and in general a lower event rate, compared to patients with ICM. However, subgroups of NDCM patients may benefit from their primary prophylactic ICD and further studies should investigate the need of primary prevention ICD in patients with NDCM. Abstract P1428 Figure.

scholarly journals Clinical characteristics, one-year change in ejection fraction and long-term outcomes in patients with heart failure with mid-range ejection fraction: a multicentre prospective observational study in Catalonia (Spain)

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018719 ◽  
Author(s):  
Nuria Farré ◽  
Josep Lupon ◽  
Eulàlia Roig ◽  
Jose Gonzalez-Costello ◽  
Joan Vila ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Prospective Observational Study ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
End Point ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
Baseline Characteristics

ObjectivesThe aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%–49%) and the effect of 1-year change in LVEF in this group.SettingMulticentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units.ParticipantsFourteen per cent (n=504) of the 3580 patients included had HFmrEF.InterventionsBaseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes.ResultsMedian follow-up was 3.66 (1.69–6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%–49% and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027) and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively).ConclusionsPatients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1 year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.

scholarly journals Clinical Outcomes in Patients with Ischemic versus Non-Ischemic Cardiomyopathy after Angiotensin-Neprilysin Inhibition Therapy

2021 ◽  
Vol 10 (21) ◽  
pp. 4989
Author(s):  
Mohammad Abumayyaleh ◽  
Christina Pilsinger ◽  
Ibrahim El-Battrawy ◽  
Marvin Kummer ◽  
Jürgen Kuschyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Tachyarrhythmias ◽  
Ventricular Ejection Fraction ◽  
One Year ◽  
The Impact

Background: The angiotensin receptor-neprilysin inhibitor (ARNI) decreases cardiovascular mortality in patients with chronic heart failure with a reduced ejection fraction (HFrEF). Data regarding the impact of ARNI on the outcome in HFrEF patients according to heart failure etiology are limited. Methods and results: One hundred twenty-one consecutive patients with HFrEF from the years 2016 to 2017 were included at the Medical Centre Mannheim Heidelberg University and treated with ARNI according to the current guidelines. Left ventricular ejection fraction (LVEF) was numerically improved during the treatment with ARNI in both patient groups, that with ischemic cardiomyopathy (n = 61) (ICMP), and that with non-ischemic cardiomyopathy (n = 60) (NICMP); p = 0.25. Consistent with this data, the NT-proBNP decreased in both groups, more commonly in the NICMP patient group. In addition, the glomerular filtration rate (GFR) and creatinine changed before and after the treatment with ARNI in both groups. In a one-year follow-up, the rate of ventricular tachyarrhythmias (ventricular tachycardia and ventricular fibrillation) tended to be higher in the ICMP group compared with the NICMP group (ICMP 38.71% vs. NICMP 17.24%; p = 0.07). The rate of one-year all-cause mortality was similar in both groups (ICMP 6.5% vs. NICMP 6.6%; log-rank = 0.9947). Conclusions: This study shows that, although the treatment with ARNI improves the LVEF in ICMP and NICMP patients, the risk of ventricular tachyarrhythmias remains higher in ICMP patients in comparison with NICMP patients. Renal function is improved in the NICMP group after the treatment. Long-term mortality is similar over a one-year follow-up.

P4525Differential effect of CRT in ischemic and non-ischemic cardiomyopathy: longterm follow-up data from a single center cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P C Kahr ◽  
P Kaufmann ◽  
J Kuster ◽  
J Tonko ◽  
A Breitenstein ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Male Gender ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Study Endpoint ◽  
Ventricular Ejection Fraction

Abstract Background Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in selected symptomatic patients with reduced left ventricular ejection fraction (LVEF) and wide QRS complex. However, some patients fail to benefit from CRT. Data on the differential role of baseline and follow-up left ventricular ejection fraction (LVEF) on outcome in patients with ischemic compared to non-ischemic cardiomyopathy (ICM, N-ICM) is controversial. Purpose To test, whether ICM and N-ICM patients differ in outcome after CRT during long-term follow-up and whether predictors for survival after CRT differ between the two groups. Methods All patients undergoing CRT implantation at our institution between November 2000 and January 2015 were evaluated (n=418). All ICM/N-ICM patients with follow-up echocardiography within 1 year after CRT implantation (FU1) and a second echocardiography >1 year after FU1 (FU2) were included in the analysis (n=253). Primary post-hoc defined study endpoint was the composite of all-cause death, heart transplantation or implantation of a ventricular assist device. Results Compared to patients with N-ICM (n=160, median age 64 years [IQR 54–71], 71% male), ICM patients (n=93, median age 70 years [IQR 61–75], 84% male) were significantly older and had a higher prevalence of male gender, concomitant diabetes mellitus and arterial hypertension. There were no significant differences in pre-implantation echocardiographic features (LVEF, LVEDV, RV-FAC, severity of mitral regurgitation), QRS width and NT-proBNP levels between the groups. However, the hazard for reaching the primary endpoint was significantly higher in patients with ICM compared to N-ICM both on univariate analysis (HR 1.62 [95% CI 1.09–2.42], p=0.018) and after multivariate correction (aHR 2.13 [1.24–3.66], p=0.006). While higher NT-proBNP levels and greater right ventricular fractional area change were positively correlated with the hazard of death in both ICM and N-ICM (see Figure), lower LVEF at baseline was associated with an increased risk of death only in ICM but not in N-ICM (HR 0.95 [0.91–0.99], p=0.029 vs. HR 1.00 [0.96–1.04], p=0.945). Male gender, lower BMI and NYHA class ≥ III were positively correlated with the endpoint in N-ICM, but not in ICM. Importantly, LVEF at FU1 (median 4.7 months after implantation) and FU2 (median 47.1 months after implantation) were found to correlate signficantly with the endpoint in both ICM and N-ICM. Conclusion Our findings highlight important differences in ischemic and non-ischemic patient populations undergoing CRT. While overall survival of patients with N-ICM exceeds survival in ICM, several other factors (including LVEF) have differential effects on response to CRT in these two patient groups.

P6209Relationship between skin autofluorescence levels and clinical outcomes in heart failure patients undergoing cardiac rehabilitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kunimoto ◽  
K Shimada ◽  
M Yokoyama ◽  
A Honzawa ◽  
M Yamada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Cox Regression ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Skin Autofluorescence ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background Advanced glycation end-products, indicated by skin autofluorescence (SAF) levels, could be prognostic predictors of all-cause and cardiovascular mortality in patients with diabetes mellitus (DM) and renal disease. However, the clinical usefulness of SAF levels in patients with heart failure (HF) who underwent cardiac rehabilitation (CR) remains unclear. Purpose The purpose of this study was to investigate the prognostic value of SAF levels in patients with HF who underwent CR. Methods This study enrolled 204 consecutive patients with HF who had undergone CR at our university hospital between November 2015 and October 2017. Clinical characteristics and anthropometric data were collected at the beginning of CR. SAF levels were noninvasively measured with an autofluorescence reader. The major adverse cardiovascular event (MACE) was a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data concerning primary endpoints were collected until November 2018. Results Patients' mean age was 68.1 years, and 61% were males. Patients were divided into two groups according to the median SAF levels (high and low SAF groups). Patients in the high SAF group were significantly older, had a higher prevalence of chronic kidney disease, and histories of coronary artery bypass surgery; however, there were no significant between-group differences in sex, prevalence of DM, left ventricular ejection fraction, and physical function. During a median follow-up period of 623 days, 25 patients experienced all-cause mortality and 34 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the high SAF group had a higher incidence of MACE (log-rank P<0.05), whereas when patients were divided into two groups according to the median hemoglobin A1c level, no significant between-group difference was observed for the incidence of MACE (Figure). After adjusting for confounding factors, Cox regression multivariate analysis revealed that SAF levels were independently associated with the incidence of MACE (hazard ratio: 1.74, 95% confidence interval: 1.12–2.65, P<0.05). Figure 1 Conclusion SAF levels were significantly associated with the incidence of MACE in patients with HF and may be useful for risk stratification in patients with HF who undergo CR.

scholarly journals 84 Left atrial reverse remodelling in dilated cardiomyopathy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo Nuzzi ◽  
Anne Raafs ◽  
Paolo Manca ◽  
Michiel T.h.M. Henkens ◽  
Caterina Gregorio ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Left Atrial ◽  
Tertiary Care ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Linear Association ◽  
Lower Baseline ◽  
Reverse Remodelling

Abstract Aims Left atrial (LA) dilation is associated a with worse prognosis in several cardiovascular settings but therapies can promote LA reverse remodelling. Characterizing and defining the prognostic implications of LA volume (LAVI) reduction in dilated cardiomyopathy (DCM). Methods and results Consecutive DCM patients from two tertiary care centres, with available echocardiography at baseline and at 1 year follow-up, were analysed. LA dilation was defined as LAVI &gt;34 ml/m2, Delta (Δ)LAVI was defined as the 1 year relative LAVI reduction. The outcome was a composite of death/heart transplantation/heart failure hospitalization (D/HTx/HFH). Five hundred sixty patients were included [age 52 ± 13 years; left ventricular ejection fraction (LVEF) 31 ± 10%, LAVI 45 ± 18 ml/m2]. Baseline LAVI had a non-linear association with the risk of D/HTx/HFH, independently from LVEF (P &lt; 0.001). At 1 year follow-up, LAVI decreased in 374 patients (67%, median ΔLAVI 24%, interquartile range 37% 11%). Factors independently associated with ΔLAVI were higher baseline LAVI and lower baseline LVEF. After adjustment for confounders, ΔLAVI showed a linear association with the risk of D/HTx/HHF (HR: 0.92, 95% CI: 0.86 0.99 per 5% decrease, P &lt; 0.001). At 1 year Follow-up, patients with a ≥ 15% reduction in ΔLAVI or LAVI normalization (i.e. Follow-up LAVI ≤34ml/m2) (42% of the cohort) were at lower risk of D/HTx/HFH (HR: 0.49, 95% CI: 0.33 0.74, P &lt; 0.001). Conclusions In a large cohort of DCM, 1 year reduction in LAVI is observed in the majority of patients. The association between reduction in LAVI and D/HTx/HHF candidates LA reverse remodelling as complementary early therapeutic goal in DCM.

scholarly journals 85 Diuretics trajectories in dilated cardiomyopathy

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo Nuzzi ◽  
Antonio Cannatà ◽  
Paolo Manca ◽  
Caterina Gregorio ◽  
Giulia Barbati ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Nyha Class ◽  
Diuretic Therapy ◽  
Left Ventricular ◽  
Equivalent Dose ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
Kaplan Meier

Abstract Aims Diuretics in heart failure (HF) are commended to relieve symptoms at lowest dosage effective. Dilated cardiomyopathy (DCM) is a particular HF setting with several variables that may influence disease trajectory. We aimed to assess the long-term use of diuretics in DCM, the possibility of withdrawal and to explore the prognostic correlations. Methods and results All consecutive DCM patients enrolled from 1990 to 2018 were considered eligible. All the patients had available the information about the furosemide-equivalent dose at baseline and at follow-up evaluation within 24 months. Patients were categorized in stable (diuretic dose variation &lt;50%), increasers (diuretics dose increase ≥50% or initiation of diuretic therapy), and decreasers (diuretics dose decrease ≥50% or never prescribed diuretics in the 24-months observation period). The prognostic role of the diuretics trajectory group was assessed with Kaplan Meier analysis and with a time-dependent multivariable model. The outcome measure was a composite of all-cause death/heart transplantation/HF hospitalization (ACD/HTx/HFH). 908 patients were included [mean age 50 ± 16, 70% male sex, 24% NYHA class III or IV, mean left ventricular ejection fraction (LVEF) 31 ± 9%, 66% treated with diuretics at baseline]. The furosemide-equivalent dose at enrolment had a linear association with the risk of outcome. Compared to other groups, decreaser patients were younger, had less HF symptoms, higher LVEF and more dilated left atrium. Decreasers had a lower prescription rate of diuretics and less frequent indication to renin-angiotensin inhibitors and mineralocorticoid receptors antagonists. Over a median follow-up of 122 (62–195) months decreasers had the lowest incidence of outcome, followed by stable, while increasers had the worst outcome (P &lt; 0.001). After adjustment for other prognosticators, compared to stable patients, decreasers had a reduced risk of ACD/HTx/HFH [HR: 0.497 (95% CI: 0.337–0.731)] while increasers had the highest risk of adverse outcome [HR: 2.027 (95% CI: 1.254–3.276)]. Similarly, amongst patients taking diuretics at baseline, the diuretics withdrawal was in independent outcome predictor. The only multivariable predictors of diuretics withdrawal were younger age and lower furosemide-equivalent dose at enrolment. Conclusions In DCM patients the diuretics dose at baseline is a strong prognosticator. Diuretics dose reduction or its withdrawal provides a prognostic benefit on hard outcome. Diuretics tapering in selected patients should be considered in the short-term follow-up to improve DCM prognosis.

scholarly journals Relationship between skin autofluorescence levels and clinical events in patients with heart failure undergoing cardiac rehabilitation

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mitsuhiro Kunimoto ◽  
Miho Yokoyama ◽  
Kazunori Shimada ◽  
Tomomi Matsubara ◽  
Tatsuro Aikawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Skin Autofluorescence ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Background Advanced glycation end-products, indicated by skin autofluorescence (SAF) levels, could be prognostic predictors of all-cause and cardiovascular mortality in patients with diabetes mellitus (DM) and renal disease. However, the clinical usefulness of SAF levels in patients with heart failure (HF) who underwent cardiac rehabilitation (CR) remains unclear. This study aimed to investigate the associations between SAF and MACE risk in patients with HF who underwent CR. Methods This study enrolled 204 consecutive patients with HF who had undergone CR at our university hospital between November 2015 and October 2017. Clinical characteristics and anthropometric data were collected at the beginning of CR. SAF levels were noninvasively measured with an autofluorescence reader. Major adverse cardiovascular event (MACE) was a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data concerning primary endpoints were collected until November 2017. Results Patients’ mean age was 68.1 years, and 61% were male. Patients were divided into two groups according to the median SAF levels (High and Low SAF groups). Patients in the High SAF group were significantly older, had a higher prevalence of chronic kidney disease, and more frequently had history of coronary artery bypass surgery; however, there were no significant between-group differences in sex, prevalence of DM, left ventricular ejection fraction, and physical function. During a mean follow-up period of 590 days, 18 patients had all-cause mortality and 36 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the high SAF group had a higher incidence of MACE (log-rank P < 0.05). After adjusting for confounding factors, Cox regression multivariate analysis revealed that SAF levels were independently associated with the incidence of MACE (odds ratio, 1.86; 95% confidence interval, 1.08–3.12; P = 0.03). Conclusion SAF levels were significantly associated with the incidence of MACE in patients with HF and may be useful for risk stratification in patients with HF who underwent CR.

scholarly journals Predictors of left ventricular ejection fraction recovery after transcatheter aortic valve replacement (TAVR)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Peiro Aventin ◽  
E Gambo Ruberte ◽  
T Simon Paracuellos ◽  
D Gomez Martin ◽  
A Perez Guerrero ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ejection Fraction ◽  
Transcatheter Aortic Valve Replacement ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality

Abstract Introduction Transcatheter aortic valve replacement (TAVR) has proven benefits in patients with reduced left ventricular ejection fraction (LVEF). A significant proportion of them shows recovery of systolic function Objective To analyse the main baseline, electrocardiographic and echocardiographic characteristics that may predict LVEF recovery after TAVR. Methods A cohort study was conducted. Consecutive patients undergoing TAVR in our center from January 2012 to December 2020 were included. Baseline clinical profile, electrocardiographic (EKG), echocardiographic (ECH) parameters were recorded, as well as MACE during follow-up (major adverse cardiovascular events including: all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization). Reduced systolic function was defined as LVEF &lt;50%. We considered recovery of systolic function as LVEF ≥50% at follow-up. Results A total of 292 patients were included. 48% were women and the median age was 81.07 years (77.63–86.22). 22.6% (66 patients) had reduced LVEF at baseline. Half of them showed recovered systolic function during follow-up. Patients who did not recovered LVEF had a higher prevalence of dyslipidemia and peripheral artery disease. History of cardiac surgery was more frequently found in this group, and they showed a higher surgical risk estimated by EuroScore II. They had lower LVEF and aortic valve mean gradient, and more frequently presented non-synus rhythm (NSR), left bundle branch block and right ventricular dysfunction (RVD). These characteristics are shown in figure 1. In univariate analysis lower Euroscore II, presence of synus rhythm, absence of LBBB and RVD, as well as higher aortic valve mean gradient were predictors of LVEF recovery. In multivariate analysis RVD and mean aortic gradient were independent predictors. Among all patients included in our study, those presenting with RV dysfunction were significantly associated with lower LVEF mean values (46,0% vs 57,2%; p&lt;0,01) After a median follow-up of 21.3 (8.52–38.94) months, MACE were lower in recovered LVEF group (HR 0.25 95% CI: 0.05–1.21). There were no statistically significant differences in all-cause mortality, nevertheless there was a trend towards a higher non-cardiovascular mortality in this group, essentially at the expense of deaths from malignant neoplasms and SARS-COV-2 infections. Survival curves for MACE are represented in figure 2. Conclusion In our study, half of the patients with impaired ventricular function undergoing TAVR showed recovery of ejection fraction. Right ventricular function and aortic valve mean gradient at baseline were independent predictors of recovery. Identifying predictors of LVEF recovery is fundamental in the evaluation of potential candidates for TAVR, and can help clinicians assess risks and benefits, as well as long-term prognosis of these patients. FUNDunding Acknowledgement Type of funding sources: None. Characteristics and analysis Survival curves for MACE

Predictors of mortality and heart transplantation in patients with Chagas’ cardiomyopathy and ventricular tachycardia treated with implantable cardioverter-defibrillators

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1070-1078 ◽  
Author(s):  
Wagner L Gali ◽  
Alvaro V Sarabanda ◽  
José M Baggio ◽  
Eduardo F Silva ◽  
Gustavo G Gomes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Secondary Prevention ◽  
Heart Transplantation ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death

Aims Data on long-term follow-up of patients with Chagas’ heart disease (ChHD) receiving a secondary prevention implantable cardioverter-defibrillator (ICD) are limited and its benefit is controversial. The aim of this study was to evaluate the long-term outcomes of ChHD patients who received a secondary prevention ICD. Methods and results We assessed the outcomes of consecutive ChHD patients referred to our Institution from 2006 to 2014 for a secondary prevention ICD [89 patients; 58 men; mean age 56 ± 11 years; left ventricular ejection fraction (LVEF), 42 ± 12%]. The primary outcome included a composite of death from any cause or heart transplantation. After a mean follow-up of 59 ± 27 months, the primary outcome occurred in 23 patients (5.3% per year). Multivariate analysis showed that LVEF < 35% [hazard ratio (HR) 4.64; P < 0.01] and age ≥ 65 years (HR 3.19; P < 0.01) were independent predictors of the primary outcome. Using these two risk factors, a risk score was developed, and lower- (no risk factors), intermediate- (one risk factor), and higher-risk (two risk factors) groups were recognized with an annual rate of primary outcome of 1.4%, 7.4%, and 20.4%, respectively. A high burden of appropriate ICD therapies (16% per year) and electrical storms were documented, however, ICD interventions did not impact on the primary outcome. Conclusion Among ChHD patients receiving a secondary prevention ICD, older age (≥65 years) and left ventricular dysfunction (LVEF < 35%) portend a poor outcome and were associated with increased risk of death or heart transplantation. Most patients received appropriate ICD therapies, however, ICD interventions did not impact on the primary outcome.

Sign in / Sign up

Export Citation Format

Share Document