Clinical and anamnestic predictors of poor long-term prognosis in patients with chronic heart failure and implanted cardioverter-defibrillator

Abstract

Aim. Identification of a complex of clinical and anamnestic predictors of an unfavorable long-term prognosis in patients with heart failure with low left ventricular ejection fraction and an implanted cardioverter-defibrillator (ICD). Materials and methods. In 260 patients with heart failure with low left ventricular ejection fraction and ICD included in the ”Kuzbass Register of Patients with ICD”, data were obtained on the status of alive/dead, causes of death and cardiovascular events during a 4-year follow-up period. The clinical-instrumental and socio-demographic parameters entered into the register before ICD implantation were used to compile a prognostic regression model. Results. A total of 348 cardiovascular events (endpoints) were recorded, of which 54 were deaths. The main cause of death in 48 (88.9%) patients was acute decompensated heart failure. According to the multivariate regression analysis, the factors that increase the risk of an unfavorable long-term outcome included in the prognostic model were: the level of systolic pressure in the pulmonary artery, the thickness of the interventricular septum, social status, the presence of chronic obstructive pulmonary disease, the low ejection fraction of the left ventricle and the absence of a renin-blocker angiotensin-aldosterone system (model sensitivity – 70%, specificity – 75.9%, AUC=0.8). Conclusion. The use of a predictive model in clinical practice will make it possible to personalize approaches to making a decision on the need for ICD implantation and further monitoring of patients in order to improve their survival.

Keywords

• heart failure
• implantable cardioverter defibrillators
• sudden cardiac death
• low left ventricular ejection fraction
• prognosis