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Trajectory of Left Ventricular Ejection Fraction Among Individuals Eligible for Implantable Cardioverter-Defibrillator
  • Selma Carlson,
  • Amy Gravely,
  • Selcuk Adabag
Selma Carlson
Minneapolis VA Health Care System
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Amy Gravely
Minneapolis VA Health Care System
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Selcuk Adabag
Veterans Administration Hospita, University of Minnesota Medical School
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Objective: Examine the trajectory of left ventricular ejection fraction (EF) among patients eligible for implantable cardioverter-defibrillator (ICD) therapy Background: Ejection fraction is the cornerstone criterion for ICD therapy, but the risk of sudden cardiac death (SCD) remains after an improvement in EF. Methods: We examined the trajectory of EF among 1178 participants of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) who had 3 or more assessments of EF, at least 90 days apart. A follow-up EF >35% or >10% absolute increase in EF from baseline were examined as the criteria for EF improvement. Results: At first follow-up, 381 (32%) patients had an improvement of EF to >35%. However, EF had returned back to 35% in 109 (27%) of these patients at second follow-up. Similarly, 446 (38%) patients experienced a >10% improvement in EF at first follow-up, but 109 (24%) of these had a subsequent >10% decrease in EF at the second follow-up. Of the 32 patients with normalized EF (≥55%) at first follow-up, 18 (56%) had a subsequent >10% decrease in EF. The fluctuation in EF was present in both ischemic and non-ischemic cardiomyopathy but a higher proportion of patients with non-ischemic cardiomyopathy had an improvement in EF to >35% at first follow-up compared to those with ischemic cardiomyopathy (38% vs. 27%, p=<0.0001). Conclusion: There is substantial fluctuation of EF among patients who are eligible for ICD therapy. These data may help explain the continued risk of SCD after improvement in EF.

Peer review status:Published

31 Mar 2021Published in Pacing and Clinical Electrophysiology. 10.1111/pace.14168