Prediction of early mortality after cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: focus on transthoracic echocardiography

Abstract

Aim. To study the mortality rate of acute decompensated heart failure (ADHF) in patients with heart failure with reduced ejection fraction (HFrEF) within a year after implantation of cardioverter-defibrillator (ICD), to evaluate the potential of its prediction using transthoracic echocardiography.Material and methods. The study included 384 patients with NYHA class 3-4 heart failure with left ventricular ejection fraction (LVEF) ≤35%, who were scheduled for ICD implantation for the primary prevention of sudden cardiac death (SCD). After ICD implantation, enrolled patients were followed up for a year to record the primary endpoint of death due to ADHF.Results. During the 1-year follow-up, the primary endpoint was recorded in 38 patients (10%). A univariate logistic regression identified 14 echocardiographic parameters with the highest predictive potential (p<0,1) associated with the studied endpoint. Based on multivariate regression analysis, a prognostic model was developed, which included three factors with the highest statistical significance: LVEF, right atrial (RA) medial-lateral size, and pulmonary artery systolic pressure. The diagnostic efficiency of the model was 78,7% (sensitivity, 82,4%; specificity, 78,3%). A decrease in LVEF ≤28% and an increase in (RA) medial-lateral size ≥3,9 cm were found to be independent predictors of the studied endpoint.Conclusion. Approximately 10% of HFrEF patients selected for ICD implantation for primary prevention of SCD die due to ADHF during the 1-year follow-up. Transthoracic echocardiography has potential to predict this outcome.

Keywords

• heart failure
• acute decompensated heart failure
• predictors
• trans­thoracic echocardiography
• implantable cardioverter-defibrillator