Imaging modality for left ventricular ejection fraction estimation and effect of implantable cardioverter-defibrillator on mortality in patients with heart failure

Alexander Smith, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia.
Sant Kumar, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
Hans J. Moore, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; George Washington University, Washington, District of Columbia.
Ami E. Iskandrian, University of Alabama at Birmingham, Birmingham, Alabama.
Navin C. Nanda, University of Alabama at Birmingham, Birmingham, Alabama.
Venkatesh K. Raman, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
Steven Singh, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
Ross D. Fletcher, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
Prakash Deedwania, University of California, San Francisco, California.
Gregg C. Fonarow, University of California, Los Angeles, California.
Michael D. Greenberg, Veterans Affairs Medical Center, Washington, District of Columbia; George Washington University, Washington, District of Columbia.
Ali Ahmed, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; George Washington University, Washington, District of Columbia.
Phillip H. Lam, Veterans Affairs Medical Center, Washington, District of Columbia; Georgetown University, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: Phillip.H.Lam@medstar.net.

Document Type

Journal Article

Publication Date

3-11-2023

Journal

Heart rhythm

DOI

10.1016/j.hrthm.2023.03.010

Keywords

Echocardiography; ICD; LVEF; MUGA; Mortality; SCD-HeFT

Abstract

BACKGROUND: Implantable cardioverter-defibrillators (ICDs) improve outcomes in patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤35%. Less is known about whether outcomes varied between the 2 noninvasive imaging modalities used to estimate LVEF-2-dimensional echocardiography (2DE) and multigated acquisition radionuclide ventriculography (MUGA)-which use different principles (geometric vs count-based, respectively). OBJECTIVE: The purpose of this study was to examine whether the effect of ICD on mortality in patients with HF and LVEF ≤35% varied on the basis of LVEF measured by 2DE or MUGA. METHODS: Of the 2521 patients with HF with LVEF ≤35% in the Sudden Cardiac Death in Heart Failure Trial, 1676 (66%) were randomized to either placebo or ICD, of whom 1386 (83%) had LVEF measured by 2DE (n = 971) or MUGA (n = 415). Hazard ratios (HRs) and 97.5% confidence intervals (CIs) for mortality associated with ICD were estimated overall, checking for interaction, and within the 2 imaging subgroups. RESULTS: Of the 1386 patients in the present analysis, all-cause mortality occurred in 23.1% (160 of 692) and 29.7% (206 of 694) of patients randomized to ICD or placebo, respectively (HR 0.77; 97.5% CI 0.61-0.97), which is consistent with that in 1676 patients in the original report. HRs (97.5% CIs) for all-cause mortality in the 2DE and MUGA subgroups were 0.79 (0.60-1.04) and 0.72 (0.46-1.11), respectively (P = .693 for interaction). Similar associations were observed for cardiac and arrhythmic mortalities. CONCLUSION: We found no evidence that in patients with HF and LVEF ≤35%, the effect of ICD on mortality varied by the noninvasive imaging method used to measure LVEF.

Department

Medicine

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