Abstract
Aims
Patients with non-ischemic systolic heart failure have an increased risk of malignant
ventricular arrhythmias and sudden cardiovascular death. Since the risk is less pronounced
than for patients with ischemic cause of heart failure more discriminating tools are
needed to identify patients most likely to benefit from implantable cardioverter-defibrillator
(ICD) implantation. Right ventricular (RV) dysfunction is associated with a worse
prognosis, but whether RV free wall strain (RV-FWS) measured with echocardiography
can identify the patients most likely to benefit from ICD implantation is not known.
Methods
In this extended follow-up analysis of the Danish Study to Assess the Efficacy of
ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial,
RV-FWS was measured with echocardiography in 445 patients prior to randomization.
RV dysfunction was defined as RV-FWS > -20%. The primary endpoint was all-cause mortality.
Results
Median RV-FWS was -18% (quartiles: -23% to -14%), and RV dysfunction was measured
in 255 (57%) patients. During a median follow-up of 5.7 years, 170 (38%) patients
died. There was a statistically significant interaction between RV dysfunction and
the effect of ICD implantation (p=0.003), also after adjusting for known cardiovascular risk factors (p=0.01). ICD implantation significantly reduced all-cause mortality in patients with
RV dysfunction, HR 0.54 (95% CI 0.36-0.80), p = 0.002, but not in patients with normal RV function, HR 1.34 (95% CI 0.84-2.12),
p = 0.22.
Conclusions
In patients with non-ischemic systolic heart failure, RV dysfunction on echocardiography
was associated with greater effect of ICD implantation and could be used to select
patients with benefit from ICD treatment.
GA
Graphical Abstract
Key words
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Article info
Publication history
Accepted:
December 21,
2022
Received in revised form:
December 20,
2022
Received:
September 22,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc.
