Kidney Dysfunction and Deterioration of Ejection Fraction Pose Independent Risk Factors for Mortality in Implantable Cardioverter-Defibrillator Recipients for Primary Prevention
Article first published online: 15 JUN 2012
© 2012 Wiley Periodicals, Inc.
Volume 35, Issue 9, pages 575–579, September 2012
How to Cite
Kreuz, J., Horlbeck, F., Schrickel, J., Linhart, M., Fimmers, R., Mellert, F., Nickenig, G. and Schwab, J. O. (2012), Kidney Dysfunction and Deterioration of Ejection Fraction Pose Independent Risk Factors for Mortality in Implantable Cardioverter-Defibrillator Recipients for Primary Prevention. Clin Cardiol, 35: 575–579. doi: 10.1002/clc.22018
- Issue published online: 10 SEP 2012
- Article first published online: 15 JUN 2012
- Manuscript Revised: 27 APR 2012
- Manuscript Received: 13 JAN 2012
A growing number of patients with advanced heart failure fulfill a primary-prevention indication for an implantable cardioverter-defibrillator (ICD). This study seeks to identify new predictors of overall mortality in a Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)-like collective to enhance risk stratification.
An impaired renal function and severely depressed left ventricular ejection fraction pose relevant risk factors for mortality in primary prevention ICD recipients.
Ninety-four consecutive ICD patients with New York Heart Association class II–III heart failure and depressed left ventricular function (left ventricular ejection fraction [LVEF] ≤35%) with no history of malignant ventricular arrhythmias were followed for 34 ± 20 months.
During this period, 30 patients died (32%). Deceased patients revealed a significantly worse renal function before ICD implantation (1.55 ± 0.7 mg/dL vs 1.1 ± 0.4 mg/dL; P = 0.007), suffered more often from coronary artery disease (53 vs 29; P = 0.006), and were older (69.5 ± 8 y vs 67 ± 12 y; P = 0.0002) than surviving patients. Furthermore, increased serum creatinine at baseline (2 mg/dL vs 1 mg/dL; odds ratio [OR]: 3.96, 95% confidence interval [CI]: 1.2–13.04, P = 0.02), presence of coronary artery disease (OR: 8.6, 95% CI: 1.1–65, P = 0.036), and low LVEF (OR per 5% baseline LVEF deterioration: 1.4, 95% CI: 1–1.8, P = 0.034) represented strong and independent predictors for overall mortality.
Impaired renal function, the presence of coronary artery disease, and reduced LVEF before implantation represent independent predictors for mortality in a cohort of patients with advanced systolic heart failure. These conditions still bear a high mortality risk, even if ICD implantation effectively prevents sudden arrhythmic death. Indeed, in patients suffering from several of the identified “high-risk” comorbidities, primary-prevention ICD implantation might have a limited survival benefit. The possible adverse effects of these comorbidities should be openly discussed with the potential ICD recipient and his or her close relatives. Clin. Cardiol. 2012 doi: 10.1002/clc.22018
The authors have no funding, financial relationships, or conflicts of interest to disclose.