Author + information
- Received February 20, 2018
- Revision received June 27, 2018
- Accepted July 19, 2018
- Published online September 12, 2018.
- Hugo Rodríguez-Zanella, MDa,b,
- Denisa Muraru, MD, PhDa,∗ (, )
- Eleonora Secco, MDa,
- Francesca Boccalini, MDa,
- Danila Azzolina, MAa,
- Patrizia Aruta, MDa,
- Elena Surkova, MD, PhDa,c,
- Davide Genovese, MDa,
- Giacomo Cavalli, MDa,
- Giuseppe Sammarco, MDa,
- Niccolò Ruozi, MDa,
- Rosaria M. Tenaglia, MDa,
- Oscar Calvillo-Argüelles, MDb,
- Chiara Palermo, BSca,
- Sabino Iliceto, MDa and
- Luigi P. Badano, MD, PhDa
- aDepartment of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
- bNational Institute of Cardiology of Mexico, Ignacio Chávez, México City, Mexico
- cRoyal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
- ↵∗Address for correspondence:
Dr. Denisa Muraru, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
Objectives The study sought to evaluate the potential clinical impact of using 3-dimensional echocardiography (3DE) to measure left ventricular ejection fraction (LVEF) in patients considered for implantable cardioverter-defibrillator (ICD) implantation and to assess the predictive value of 3DE LVEF for arrhythmic events.
Background ICD therapy is currently recommended to prevent sudden cardiac death in patients with symptomatic heart failure and LVEF ≤35%, and in asymptomatic patients with ischemic heart disease and LVEF ≤30%. Two-dimensional echocardiography (2DE) is currently used to calculate LVEF. However, 3DE has been reported to be more reproducible and accurate than 2DE to measure LVEF.
Methods The study prospectively enrolled 172 patients with LV dysfunction (71% ischemic). Both 2DE and 3DE LVEF were obtained during the same study. The outcome was the occurrence of major arrhythmic events (sudden cardiac death, aborted cardiac arrest, appropriate ICD therapy).
Results After a median follow up of 56 (range 18 to 65) months, major arrhythmic events occurred in 30% of the patients. Compared with 2DE, 3DE changed the assignment above or below the LVEF thresholds for ICD implantation in 20% of patients, most of them having 2DE LVEFs within ± 10% from threshold. By cause-specific hazard model, 3DE LVEF was the only independent predictor of the occurrence of major arrhythmic events.
Conclusions LVEF by 3DE was an independent predictor of major arrhythmic events and improved arrhythmic risk prediction in patients with LV dysfunction. When compared with 2DE LVEF, 3DE measurement of LVEF may change the decision to implant an ICD in a sizable number of patients.
- 2-dimensional echocardiography
- 3-dimensional echocardiography
- implantable cardioverter-defibrillators
- left ventricular dysfunction
- left ventricular ejection fraction
- sudden cardiac death
- ventricular arrhythmias
The study was funded by Regione Veneto under the program ricerca sanitaria finalizzata RP-2014-00000409 (grant # CUP I52I15000100007). Drs. Muraru and Badano have received equipment grants from and served on the Speakers Bureaus of GE Vingmed and TomTec Imaging Systems. Dr. Rodríguez-Zanella has received a training grant from the National Institute of Cardiology of Mexico and the Mexican Society of Cardiology. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.
- Received February 20, 2018.
- Revision received June 27, 2018.
- Accepted July 19, 2018.
- 2018 American College of Cardiology Foundation
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