title: Predictors of death and occurrence of appropriate implantable defibrillator therapies in patients with ischemic cardiomyopathy.
abstract: Most patients with chronic ischemia and an implantable cardiac defibrillator (ICD) for primary prevention do not experience therapies for ventricular arrhythmias on follow-up. The present study aimed to identify independent clinical, electrocardiographic, and echocardiographic predictors of death and occurrence of ICD therapy in patients with chronic ischemic cardiomyopathy and ICD for primary prevention. A total of 424 patients with chronic ischemic cardiomyopathy, ejection fraction ≤ 35%, and New York Heart Association (NYHA) class ≥ II were recruited. All patients underwent echocardiography before ICD insertion. Primary outcome was all-cause mortality; secondary outcome was occurrence of appropriate ICD therapy on follow-up. Primary and secondary outcomes occurred in 84 and 95 patients, respectively. Patients who died were more likely to have diabetes (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.00 to 2.79, p = 0.049), higher NYHA class (HR 1.96, 95% CI 1.15 to 3.33, p = 0.013), lower peri-infarct strain on echocardiogram (HR 1.25, 95% CI 1.07 to 1.46, p = 0.005), and lower glomerular filtration rate (HR 1.01, 95% CI 1.00 to 1.03, p = 0.022). Only peri-infarct strain (HR 1.22, 95% CI 1.09 to 1.36, p < 0.001) predicted the occurrence of ICD therapy on follow-up. In conclusion, in chronic ischemic patients with an ICD for primary prevention, the presence of diabetes, renal dysfunction, higher NYHA class, and impaired peri-infarct zone function were predictors of all-cause mortality. In contrast, only impaired peri-infarct zone function determined the occurrence of appropriate ICD therapy on follow-up.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: C Jan Willem
authors.initials: CJ
authors.lastname: Borleffs
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Sebastiaan R D
authors.initials: SR
authors.lastname: Piers
authors.forename: Joep
authors.initials: J
authors.lastname: Thijssen
authors.forename: Gaetano
authors.initials: G
authors.lastname: Nucifora
authors.forename: Miriam
authors.initials: M
authors.lastname: Shanks
authors.forename: See Hooi
authors.initials: SH
authors.lastname: Ewe
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Nico R L
authors.initials: NR
authors.lastname: van de Veire
authors.forename: Dominic Y
authors.initials: DY
authors.lastname: Leung
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D016037:Single-Blind Method; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome