Adding Defibrillation Therapy to Cardiac Resynchronization on the Basis of the Myocardial Substrate
Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT).
OBJECTIVES: The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure.
METHODS: This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n = 4,037) or without (n = 1,270) a defibrillator. Propensity-score and cause-of-death analyses were used to compare outcomes.
RESULTS: After a mean follow-up period of 41.4 ± 29.0 months, patients with ICM had better survival when receiving CRT with a defibrillator compared with those who received CRT without a defibrillator (hazard ratio for mortality adjusted on propensity score and all mortality predictors: 0.76; 95% confidence interval [CI]: 0.62 to 0.92; p = 0.005), whereas in patients with DCM, no such difference was observed (hazard ratio: 0.92; 95% CI: 0.73 to 1.16; p = 0.49). Compared with recipients of defibrillators, the excess mortality in patients who did not receive defibrillators was related to sudden cardiac death in 8.0% among those with ICM but in only 0.4% of those with DCM.
CONCLUSIONS: Among patients with heart failure with indications for CRT, those with DCM may not benefit from additional primary prevention implantable cardioverter-defibrillator therapy, as opposed to those with ICM.
| Errataetall: |
CommentIn: J Am Coll Cardiol. 2017 Apr 4;69(13):1679-1682. - PMID 28359512 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:69 |
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| Enthalten in: |
Journal of the American College of Cardiology - 69(2017), 13 vom: 04. Apr., Seite 1669-1678 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Barra, Sérgio [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 10.07.2017 Date Revised 13.07.2017 published: Print CommentIn: J Am Coll Cardiol. 2017 Apr 4;69(13):1679-1682. - PMID 28359512 Citation Status MEDLINE |
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| doi: |
10.1016/j.jacc.2017.01.042 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM27047868X |
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| 500 | |a CommentIn: J Am Coll Cardiol. 2017 Apr 4;69(13):1679-1682. - PMID 28359512 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Patients with nonischemic dilated cardiomyopathy (DCM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy (ICM). In addition, DCM has been identified as a predictor of positive response to cardiac resynchronization therapy (CRT) | ||
| 520 | |a OBJECTIVES: The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT, according to underlying heart disease, in a large study group of primary prevention patients with heart failure | ||
| 520 | |a METHODS: This was an observational, multicenter, European cohort study of 5,307 consecutive patients with DCM or ICM, no history of sustained ventricular arrhythmias, who underwent CRT implantation with (n = 4,037) or without (n = 1,270) a defibrillator. Propensity-score and cause-of-death analyses were used to compare outcomes | ||
| 520 | |a RESULTS: After a mean follow-up period of 41.4 ± 29.0 months, patients with ICM had better survival when receiving CRT with a defibrillator compared with those who received CRT without a defibrillator (hazard ratio for mortality adjusted on propensity score and all mortality predictors: 0.76; 95% confidence interval [CI]: 0.62 to 0.92; p = 0.005), whereas in patients with DCM, no such difference was observed (hazard ratio: 0.92; 95% CI: 0.73 to 1.16; p = 0.49). Compared with recipients of defibrillators, the excess mortality in patients who did not receive defibrillators was related to sudden cardiac death in 8.0% among those with ICM but in only 0.4% of those with DCM | ||
| 520 | |a CONCLUSIONS: Among patients with heart failure with indications for CRT, those with DCM may not benefit from additional primary prevention implantable cardioverter-defibrillator therapy, as opposed to those with ICM | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a all-cause mortality | |
| 650 | 4 | |a cause of death analysis | |
| 650 | 4 | |a dilated cardiomyopathy | |
| 650 | 4 | |a implantable cardioverter-defibrillator | |
| 650 | 4 | |a ischemic cardiomyopathy | |
| 650 | 4 | |a sudden cardiac death | |
| 700 | 1 | |a Boveda, Serge |e verfasserin |4 aut | |
| 700 | 1 | |a Providência, Rui |e verfasserin |4 aut | |
| 700 | 1 | |a Sadoul, Nicolas |e verfasserin |4 aut | |
| 700 | 1 | |a Duehmke, Rudolf |e verfasserin |4 aut | |
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