Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022;29(6):978-984.
doi: 10.5603/CJ.a2020.0187. Epub 2021 Jan 13.

Factors and outcomes associated with improved left ventricular systolic function in patients with cardiomyopathy

Dylan S Eiger  1 , Lurdes Y T Inoue  2 , Qijun Li  2 , Gust Bardy  3 , Kerry Lee  4   5 , Jeanne Poole  6 , Daniel Mark  4   7 , Zainab Samad  4 , Daniel Friedman  4 , Daniel Fishbein  6 , Gillian Sanders  4   7 , Sana M Al-Khatib  4   7
Affiliations
Randomized Controlled Trial

Factors and outcomes associated with improved left ventricular systolic function in patients with cardiomyopathy

Dylan S Eiger et al. Cardiol J. 2022.

Abstract

Background: Many patients in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) had a significant improvement (> 10%) in the left ventricular ejection fraction (LVEF) during the course of the study, but the factors and outcomes associated with such improvement are uncertain.

Methods: We examined factors and rates of mortality, cause-specific mortality, and implantable cardioverter-defibrillator (ICD) shocks associated with improvement in LVEF by analyzing patients in the SCD-HeFT who were randomized to placebo or an ICD and who had an LVEF checked during follow-up.

Results: During a median follow-up of 3.99 years, of 837 patients who had at least two follow-up LVEF measurements, 276 (33%) patients had > 10% improvement in LVEF and 561 (67%) patients had no significant change in LVEF. Factors significantly associated with LVEF improvement included female sex, white race, history of hypertension, a QRS duration < 120 ms, and beta-blocker use. Improvement in LVEF was associated with a significant improvement in survival. There was no significant association between improvement in LVEF and cause-specific death, but there was a significant association between improvement in LVEF and reduced risk of receiving appropriate ICD shocks.

Conclusions: About a third of patients in this analysis, who were randomized to placebo or an ICD in SCD-HeFT, had a significant improvement in LVEF during follow-up; improvement in LVEF was associated with improved survival but not with cause-specific death, and with decreased likelihood of receiving appropriate ICD shocks.

Keywords: arrhythmia; defibrillator; heart failure; implantable; sudden cardiac death.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for groups defined by left ventricular ejection fraction (LVEF). The number of patients at risk for each year in each LVEF category since randomization is listed below the Kaplan-Meier curve.
Figure 2
Figure 2
Cumulative incidence functions of cause-specific mode of death for left ventricular ejection fraction (LVEF) groups. Group 1 (solid lines) refers to patients who experienced no change (≤ 10% improvement) in LVEF while Group 2 (dashed lines) refers to patients who demonstrated an improvement of > 10% in LVEF.
See this image and copyright information in PMC

References

    1. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2018;138(13):e272–e391. doi: 10.1161/CIR.0000000000000549. - DOI - PubMed
    1. Bardy G, Lee K, Mark D, et al. Amiodarone or an Implantable Cardioverter–Defibrillator for Congestive Heart Failure. N Engl J Med. 2005;352(3):225–237. doi: 10.1056/nejmoa043399.. - DOI - PubMed
    1. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–883. doi: 10.1056/NEJMoa013474. - DOI - PubMed
    1. Kalogeropoulos AP, Fonarow GC, Georgiopoulou V, et al. Characteristics and outcomes of adult outpatients with heart failure and improved or recovered ejection fraction. JAMA Cardiol. 2016;1(5):510–518. doi: 10.1001/jamacardio.2016.1325. - DOI - PubMed
    1. Thomas KL, Al-Khatib SM, Lokhnygina Y, et al. Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality. Am Heart J. 2008;155(1):87–93. doi: 10.1016/j.ahj.2007.09.010. - DOI - PubMed

Publication types