TY - JOUR
T1 - A risk score to predict the absence of left ventricular reverse remodeling
T2 - Implications for the timing of ICD implantation in primary prevention
AU - Pérez-Rodon, Jordi
AU - Galve, Enrique
AU - Pérez-Bocanegra, Carmen
AU - Soriano-Sánchez, Teresa
AU - Recio-Iglesias, Jesús
AU - Domingo-Baldrich, Eva
AU - Alzola-Guevara, Mila
AU - Ferreira-González, Ignacio
AU - Marsal, Josep Ramon
AU - Ribera-Solé, Aida
AU - Gutierrez García-Moreno, Laura
AU - Cruz-Carlos, Luz María
AU - Rivas-Gandara, Nuria
AU - Roca-Luque, Ivo
AU - Francisco-Pascual, Jaume
AU - Evangelista-Masip, Artur
AU - Moya-Mitjans, Àngel
AU - García-Dorado, David
N1 - Publisher Copyright:
© 2017 Japanese College of Cardiology
PY - 2018/5
Y1 - 2018/5
N2 - Background: A prophylactic implantable cardioverter defibrillator (ICD) in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) is only indicated when left ventricular ejection fraction (LVEF) reassessment remains ≤35% after 3–6 months on optimal pharmacological therapy. However, LVEF may not improve during this period and the patient may be exposed to an unnecessary risk of sudden cardiac death. This study aimed to determine the incidence and predictors of the absence of left ventricular reverse remodeling (LVRR) after pharmacological treatment optimization in patients with HFrEF to design a risk score of absence of LVRR. Methods: Consecutive outpatients with LVEF ≤35% were included in this observational prospective study. Up-titration of angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradine was performed in our Heart Failure (HF) Unit. The absence of LVRR was defined as the persistence of an LVEF ≤35% at the 6-month follow-up. Results: One hundred and twenty patients were included. At the 6-month follow-up, 64%, 76%, 72%, and 7% of patients were at 100% of the target dose of ACE inhibitors/ARBs, beta-blockers, MRAs, and ivabradine, respectively. LVRR was observed in 48% of the patients. Ischemic cardiomyopathy, prolonged HF duration, and larger left ventricular end-diastolic diameter index (LVEDDI) were independent predictors of the absence of LVRR. The risk score based on these predictors showed a c-statistic value of 0.81. Conclusions: Pharmacological treatment optimization is associated with LVRR in approximately half of cases, reducing potential ICD indications in parallel. However, ischemic cardiomyopathy, prolonged HF duration, and larger LVEDDI predict the absence of LVRR and favor ICD implantation without delay. The risk score based on the former predictors may help the clinician with the timing of ICD implantation.
AB - Background: A prophylactic implantable cardioverter defibrillator (ICD) in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) is only indicated when left ventricular ejection fraction (LVEF) reassessment remains ≤35% after 3–6 months on optimal pharmacological therapy. However, LVEF may not improve during this period and the patient may be exposed to an unnecessary risk of sudden cardiac death. This study aimed to determine the incidence and predictors of the absence of left ventricular reverse remodeling (LVRR) after pharmacological treatment optimization in patients with HFrEF to design a risk score of absence of LVRR. Methods: Consecutive outpatients with LVEF ≤35% were included in this observational prospective study. Up-titration of angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradine was performed in our Heart Failure (HF) Unit. The absence of LVRR was defined as the persistence of an LVEF ≤35% at the 6-month follow-up. Results: One hundred and twenty patients were included. At the 6-month follow-up, 64%, 76%, 72%, and 7% of patients were at 100% of the target dose of ACE inhibitors/ARBs, beta-blockers, MRAs, and ivabradine, respectively. LVRR was observed in 48% of the patients. Ischemic cardiomyopathy, prolonged HF duration, and larger left ventricular end-diastolic diameter index (LVEDDI) were independent predictors of the absence of LVRR. The risk score based on these predictors showed a c-statistic value of 0.81. Conclusions: Pharmacological treatment optimization is associated with LVRR in approximately half of cases, reducing potential ICD indications in parallel. However, ischemic cardiomyopathy, prolonged HF duration, and larger LVEDDI predict the absence of LVRR and favor ICD implantation without delay. The risk score based on the former predictors may help the clinician with the timing of ICD implantation.
KW - Implantable cardioverter defibrillator
KW - Left ventricular reverse remodeling
KW - Pharmacological treatment optimization
KW - Risk score
KW - Implantable cardioverter defibrillator
KW - Left ventricular reverse remodeling
KW - Pharmacological treatment optimization
KW - Risk score
KW - Implantable cardioverter defibrillator
KW - Left ventricular reverse remodeling
KW - Pharmacological treatment optimization
KW - Risk score
UR - http://www.scopus.com/inward/record.url?scp=85034831633&partnerID=8YFLogxK
U2 - 10.1016/j.jjcc.2017.10.019
DO - 10.1016/j.jjcc.2017.10.019
M3 - Article
C2 - 29183646
AN - SCOPUS:85034831633
SN - 0914-5087
VL - 71
SP - 505
EP - 512
JO - Journal of Cardiology
JF - Journal of Cardiology
IS - 5
ER -