Affiliation:
1. Astrakhan State Medical University; Federal Center for Cardiovascular Surgery
2. Federal Center for Cardiovascular Surgery
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.
Subject
Cardiology and Cardiovascular Medicine