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Background: Clinical parameters linked to a low benefit of ICD implantation and increased mortality risks are needed for an individualized assessment of potential benefits and risks of ICD implantation., Methods: Analysis of a prospective registry of all patients hospitalized from 2009 to 2019 in a single centre for a first implantation of any type of ICD., Results: A total of 2,681 patients were included in the registry. Until the end of follow-up (38.4 ± 29.1 months), 682 (25.4%) patients died. The one-year mortality in all patients, the one-year CV mortality, the three-year mortality in all patients, and the three-year CV mortality were 7.8%, 5.7%, 20.6%, and 14.8%, respectively. There was a statistically significant difference when the subgroups were compared according to the type of cardiomyopathy. No significant difference was found between primary and secondary prevention and between the types of devices. Male gender, age ≥ 75 years, diabetes mellitus, and atrial fibrillation were associated with a significantly increased mortality risk., Conclusion: In an analysis of a long-term follow-up of 2,681 ICD patients, we found no mortality difference between patients with ischemic or non-ischemic cardiomyopathy and in the device type. A higher mortality risk was found in men, patients older than 75 years, diabetics, and those with atrial fibrillation., Competing Interests: The authors report no conflicts of interest in this work.

Background: Primary preventive implantation of implantable defibrillator (ICD) is according to current guidelines indicated in patients with heart failure NYHA (New York Heart Association) class II/III and LVEF <35%. Thanks to advances in heart failure pharmacotherapy, a decrease in mortality could render a benefit of ICD insufficient to justify its implantation in some patients., Methods: Study design: multicenter, prospective, randomized, controlled trial evaluating the benefit of implantation of Cardiac Resynchronization and Defibrillator Therapy (CRT-D) or CRT Alone (CRT-P) in non-ischemic patients with reduced left ventricle ejection fraction (LVEF) and optimal pharmacotherapy without significant mid-wall myocardial fibrosis detected by cardiac magnetic resonance (CMR). The primary end-point: Re-hospitalization for heart failure, ventricular tachycardia, major adverse cardiac events (MACE). The secondary end-points: Sudden cardiac death, cardiovascular death, resuscitated cardiac arrest or sustained ventricular tachycardia, device-related complications, and change in quality of life. Course of the study: After a pharmacotherapy is optimized and significant mid-wall myocardial fibrosis excluded, patients will be randomized 1:1 to CRT-P or CRT-D implantation., Discussion: If our hypothesis is confirmed, this could provide evidence for the management of these patients with a significant impact on common daily praxis and health care expenditures., Clinicaltrials: gov, NCT04139460., Competing Interests: The authors report no conflicts of interest in this work.

Patients with ischemic heart disease and depressed left ventricular (LV) ejection fraction (LVEF) develop varying degrees of LV remodeling after cardiac surgical revascularization. Fifty-three patients with stable ischemic heart disease and impaired LV function (LVEF 34.9 ± 4%) were prospectively followed up for 24 months. Thirty-seven patients underwent coronary artery bypass grafting (CABG), 16 patients were treated conservatively. Cardiac magnetic resonance imaging (MRI) and SPECT were performed at baseline and after 12 and 24 months of follow-up. The patients were divided into responders and non-responders depending on the degree of LVEF improvement at 24 months follow-up (>5%-responders). MRI with ≤5 segments with DE/wall thickness ratio (DEWTR) ≥50% predicted LV reverse remodeling with a sensitivity of 86% and a specificity of 75% (AUC 0.81). An MRI finding of ≤2 segments with the DEWTR ≥75% had a corresponding sensitivity of 71% and specificity of 67% (AUC 0.75) while fixed perfusion defect on SPECT <16.5% of LV predicted reverse remodeling with a sensitivity of 64% and a specificity of 69% (AUC 0.64). A preoperative number of segments with the DE/wall thickness ratio of ≥50 and ≥75% obtained by MRI, was found to be a better predictor of left ventricular reverse remodeling than fixed perfusion defect by SPECT. No other MRI or SPECT parameter predicted LVEF improvement at 24 months after CABG., (© Springer Science+Business Media, B.V. 2010)

Aim: The aim of this study was to assess accuracy of echocardiography in the measurement of left ventricular ejection fraction (LVEF), enddiastolic volume (EDV) and endsystolic volume (ESV) compared with gated SPECT., Methods: A total of 70 patients with left ventricular systolic dysfunction were enrolled to study. Median of the time interval between gated SPECT and echocardiography was 1 hour., Results: Echocardiography was in good agreement with gated SPECT for quantification of LVEF by using Simpson's method in triplane (r=0.88, p<0.001), biplane (r=0.83, p<0.001) and monoplane apical four chamber projections (A4CH) (r=0.71, p<0,001). LVEF measured by SPECT (36.6+/-11.5%) was non-significantly higher then triplane (35.9+/-10%, median dif. 0.4%), biplane (35.7+/-10%, median dif. 0.7%), A4CH monoplane (36.6+/-12.2%, median dif. 0.1%). Echocardiography correlated with SPECT in quantification of EDV using triplane (r=0.8, p<0.001), biplane (r=0.81, p<0.001) and monoplane echocardiography (r=0.76, p<0.001). EDV measured by SPECT (201.1+/-72.5 ml) was significantly different and higher then triplane (174.4,5+/-60.8 ml, median dif. 22.8), biplane (170.9+/-58.4, median dif. 28 ml) and monoplane echocardiography (173.7+/-59.3, median dif. 85.7 ml). Echocardiography correlated with SPECT in quantification of ESV by triplane (r=0.87, p<0.001), biplane (r=0.86, p<0.001) and monoplane echocardiography (r=0.83, p<0.001). ESV measured by SPECT (133.1+/-64.3) was significantly different then triplane (115.1+/-52.1, median dif. 17 ml), biplane (113.2+/-51.5, median dif. 15.5 ml) and A4CH monoplane echocardiography (112.5+/-48.8, median dif. 17.2 ml)., Conclusion: Echocardiography is a valid tool for LVEF assessment and systematically underestimates LV volumes compared with gated SPECT in patients with LV systolic dysfunction.