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Randomized Controlled Trial
. 2008 Dec;156(6):1196-200.
doi: 10.1016/j.ahj.2008.08.007. Epub 2008 Nov 6.

Ejection fraction assessment and survival: an analysis of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)

Lorne J Gula  1 , George J Klein, Anne S Hellkamp, David Massel, Andrew D Krahn, Allan C Skanes, Raymond Yee, Jill Anderson, George W Johnson, Jeanne E Poole, Daniel B Mark, Kerry L Lee, Gust H Bardy
Affiliations
Randomized Controlled Trial

Ejection fraction assessment and survival: an analysis of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)

Lorne J Gula et al. Am Heart J. 2008 Dec.

Abstract

Background: Ejection fraction (EF) is an important method of mortality prediction among cardiac patients, and has been used to identify the highest risk patients for enrollment in the defibrillator primary prevention trials. Evidence suggests that measures of EF by different imaging modalities may not be equivalent. In the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial), the type of imaging modality for EF assessment was not mandated.

Methods: Baseline assessment of EF was performed using either echocardiography, radionuclide angiography (RNA), or contrast angiography. Multivariable analysis using a Cox proportional hazards model was used to examine whether the modality of assessing EF affected the likelihood of survival.

Results: Among the 2,521 patients enrolled in SCD-HeFT, EF was measured by RNA in 616 (24%), echocardiography in 1,469 (58%), and contrast angiography in 436 (17%). Mean EF as measured by RNA was 25.1% +/- 6.9%; by echocardiography, 23.8 +/- 6.9%; and by angiography, 21.9 +/- 6.9%. These measures were significantly different (P < .001), and each pairwise comparison differed significantly (P < .001 for each). Multivariable analysis showed no significant difference in survival between patients enrolled based on RNA versus echocardiography (HR 1.06, 95% CI 0.88-1.28), RNA versus angiography (HR 1.25, 95% CI 0.97-1.62), or echocardiography versus angiography (HR 1.18, 95% CI 0.94-1.48).

Conclusions: Among patients enrolled in SCD-HeFT, the distribution of ejection fractions measured by radionuclide angiography differed from those measured by echocardiography or contrast angiograms. Survival did not differ according to modality of EF assessment.

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Figures

Figure 1
Figure 1. Ejection Fraction by Imaging Modality
Histogram of measured ejection fraction, in increments of 5%, according to imaging modality. Ejection fraction measures are skewed toward higher values among patients who underwent measurement by radionuclide scan, whereas echocardiography and contrast angiography have more symmetric distributions.
See this image and copyright information in PMC

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