Patients with nonischemic systolic heart failure have an increased risk of malignant ventricular arrhythmias and sudden cardiovascular death. Because 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 and Results
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 before randomization. RV dysfunction was defined as an RV-FWS of greater than –20%. The primary end point was all-cause mortality. The median RV-FWS was –18% (quartiles –23% to –14%), and RV dysfunction was measured in 255 patients (57%). During a median follow-up of 5.7 years, 170 patients (38%) died. There was a statistically significant interaction between RV dysfunction and the effect of ICD implantation (P = .003), also after adjusting for known cardiovascular risk factors (P = .01). ICD implantation significantly decreased all-cause mortality in patients with RV dysfunction (hazard ratio 0.54, 95% confidence interval 0.36-0.80, P = .002), but not in patients with normal RV function (hazard ratio 1.34, 95% confidence interval 0.84-2.12, P = .22).
In patients with nonischemic systolic heart failure, RV dysfunction on echocardiography was associated with a greater effect of ICD implantation and could be used to select patients with benefit from ICD treatment.
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Published online: January 25, 2023
Accepted: December 21, 2022
Received in revised form: December 20, 2022
Received: September 22, 2022
Publication stageIn Press Journal Pre-Proof
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- Forgotten No More, The People's Ventricle Has SpokenJournal of Cardiac Failure
- PreviewIt has long been known that the presence of right ventricular (RV) dysfunction in patients with heart failure and reduced systolic function is a key prognosticator of worsened prognosis and mortality . Less widely known, however, is whether the imaging biomarkers of RV dysfunction can be used for more targeted and effective use of heart failure therapies. For instance, in non-ischemic cardiomyopathy (NICM), studies have shown no benefit for secondary prevention implantable cardio-defibrillator (ICD) implantation for all-cause mortality and sudden cardiac death [2–5].