A risk score to predict the absence of left ventricular reverse remodeling: Implications for the timing of ICD implantation in primary prevention

Jordi Pérez-Rodon, Enrique Galve, Carmen Pérez-Bocanegra, Teresa Soriano-Sánchez, Jesús Recio-Iglesias, Eva Domingo-Baldrich, Mila Alzola-Guevara, Ignacio Ferreira-González, Josep Ramon Marsal, Aida Ribera-Solé, Laura Gutierrez García-Moreno, Luz María Cruz-Carlos, Nuria Rivas-Gandara, Ivo Roca-Luque, Jaume Francisco-Pascual, Artur Evangelista-Masip, Àngel Moya-Mitjans, David García-Dorado

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Abstract

© 2017 Japanese College of Cardiology 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.
Original languageEnglish
Pages (from-to)505-512
JournalJournal of Cardiology
Volume71
Issue number5
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • Implantable cardioverter defibrillator
  • Left ventricular reverse remodeling
  • Pharmacological treatment optimization
  • Risk score

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    Pérez-Rodon, J., Galve, E., Pérez-Bocanegra, C., Soriano-Sánchez, T., Recio-Iglesias, J., Domingo-Baldrich, E., Alzola-Guevara, M., Ferreira-González, I., Marsal, J. R., Ribera-Solé, A., Gutierrez García-Moreno, L., Cruz-Carlos, L. M., Rivas-Gandara, N., Roca-Luque, I., Francisco-Pascual, J., Evangelista-Masip, A., Moya-Mitjans, À., & García-Dorado, D. (2018). A risk score to predict the absence of left ventricular reverse remodeling: Implications for the timing of ICD implantation in primary prevention. Journal of Cardiology, 71(5), 505-512. https://doi.org/10.1016/j.jjcc.2017.10.019