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Right ventricular free wall strain and effect of defibrillator implantation in patients with non-ischemic systolic heart failure.

      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

      Key words

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