Abstract 12724: Chronic Heart Failure Patients whose Ejection Fraction Improves Above 35% With Medical Therapy are Still at Risk for Sudden Cardiac Death

Abstract

Background: Patients with chronic heart failure (CHF) with left ventricular ejection fraction (LVEF) less than 35% are well known to be at risk of sudden cardiac death. However, little is known whether patients whose LVEF improves above 35% with medical therapy are still at risk of sudden cardiac death. The aim of this study was to assess the effect of LVEF improvement on the prognosis in CHF patients.

Methods and Results: We studied 93 CHF outpatients with radionuclide LVEF < 35% (LVEF 26±6%, NYHA 2.1±0.7, ischemic origin 52%). Radionuclide LVEF was measured one year after the entry in all patients. LVEF improvement at one year after the entry was defined as LVEF > 35% and increase in LVEF >10% from baseline. Thirty-six of 93 patients had LVEF improvement (46±8%) one year after the entry, while the remaining 57 patients had no LVEF improvement (25±6%). There were no significant differences in baseline characteristics including age , gender, NYHA class and medications between patients with and without LVEF improvement, except for having ischemic origin ( 33% vs 63%, p<0.01) and LVEF at the entry (29±5% vs 24±6%, p<0.01). During a follow-up period of 8.1±4.1 years, 16 patients had sudden cardiac death and 13 patients had pump failure death. In 36 patients with LVEF improvement, 5 patients had sudden cardiac death and no patients had pump failure death, while 11 patients had sudden cardiac death and 13 patients had pump failure death in 56 patients without LVEF improvement. Kaplan-Meier analysis revealed that there was no significant difference in the incidence of sudden cardiac death between patients with and without LVEF improvement (14% vs 19%, p=0.44) (Fig), while pump failure death was significantly more frequently observed in patients without than with LVEF improvement (0% vs 23%, p= 0.002).

Conclusion: CHF patients with LVEF improvement still remained at risk for sudden cardiac death, although less risk for pump failure death.