| Abstract: |
Concerns about the prognostic value of NYHA functional class (FC) in heart failure (HF) patients carrying a prophylactic implantable cardioverter defibrillator (ICD) are still present. We aimed to compare whether mortality and arrhythmic risk were different, in a cohort of HF patients undergoing ICD-only implant, according to their FC. HF patients with left ventricle ejection fraction (LVEF) ≤35%, undergoing first prophylactic ICD-only implant were collected from a multicentre nationwide registry (2006-2015). Six hundred and twenty-one patients were identified (101 patients in NYHA I; 411 in NYHA II; 109 in NYHA III). After a mean follow-up of 4. 4 years (±2. 1), 126 patients died (20. 3%). All-cause mortality risk was higher in symptomatic patients: 13. 9% in NYHA I patients, 18. 3% in NYHA II patients (HR: 1. 8, 95% CI 1. 1-3. 2), and 32. 9% in NYHA III patients (HR: 3. 9, 95% CI 2. 1-7. 3). Seventy-eight out of all deaths were due to cardiovascular causes (12. 6%). Cardiovascular mortality risk was also higher in symptomatic patients: 6. 9% in NYHA I patients, 11% in NYHA II patients (HR: 2. 2, 95% CI 1. 1-4. 9), and 23. 9% in NYHA III (HR: 5. 5, 95% CI 2. 4-12. 7). One hundred and seventeen patients received a first appropriate ICD therapy (19. 4%). Arrhythmia free survival did not differ among study groups [20. 8% in NYHA I patients, 18. 7% in NYHA II (HR: 1. 1, 95% CI 0. 6-1. 7) and 20. 8% in NYHA III patients (HR: 1. 3, 95% CI 0. 7-2. 5)]. NYHA class independently predicted cardiovascular mortality (NYHA III vs. NYHA I: HR, 4. 7; 95% CI, 1. 7-12. 8, P = 0. 002; NYHA II vs. NYHA I: HR, 2. 1, 95% CI, 1. 0-5. 6, P = 0. 05) but not all-cause death (NYHA III vs. NYHA I: HR: 1. 8, 95% CI 0. 8-3. 9, P = 0. 11; NYHA II vs. NYHA I: HR, 1. 1, 95% CI 0. 6-2. 2, P = 0. 71;). Atrial fibrillation, chronic kidney disease, and diabetes emerged as predictors of both all-cause death [(HR: 1. 8, 95% CI 1. 2-2. 8, P = 0. 005), (HR: 2. 2, 95% CI 1. 4-3. 4, P < 0. 001), (HR: 2. 0, 95% CI 1. 3-3. 1, P = 0. 001), respectively] and cardiovascular mortality [(HR: 1. 8, 95% CI 1. 1-3. 1, P = 0. 02), (HR: 3. 1, 95% CI 1. 8-5. 4, P < 0. 001), (HR: 1. 7, 95% CI 1. 1-3, P = 0. 032), respectively]. Mortality in HF patients undergoing prophylactic ICD implantation was higher in symptomatic patients. NYHA functional class along with other comorbidities might be helpful to identify a subgroup of ICD carriers with poorer prognosis and higher risk of cardiovascular death. |
guest ::
(Hospital Universitario Infanta Leonor)
