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Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators
OBJECTIVE: To identify predictors of left ventricular ejection fraction (LVEF) improvement in patients with newly detected cardiomyopathy using wearable cardioverter defibrillators (WCDs). BACKGROUND: WCDs are useful in preventing sudden cardiac death in patients with reduced LVEF <35% while awai...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wiley Periodicals, Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068066/ https://www.ncbi.nlm.nih.gov/pubmed/31860745 http://dx.doi.org/10.1002/clc.23295 |
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author | Mehta, Nikhil A. Abdulsalam, Nashwa Kouides, Ruth Ahmed, Hamdy Atif, Raisa Shah, Abrar Taylor, Sarah Chuprun, Dmitry Huang, David Rao, Mohan |
author_facet | Mehta, Nikhil A. Abdulsalam, Nashwa Kouides, Ruth Ahmed, Hamdy Atif, Raisa Shah, Abrar Taylor, Sarah Chuprun, Dmitry Huang, David Rao, Mohan |
author_sort | Mehta, Nikhil A. |
collection | PubMed |
description | OBJECTIVE: To identify predictors of left ventricular ejection fraction (LVEF) improvement in patients with newly detected cardiomyopathy using wearable cardioverter defibrillators (WCDs). BACKGROUND: WCDs are useful in preventing sudden cardiac death in patients with reduced LVEF <35% while awaiting implantable cardioverter defibrillator (ICD) placement. In many patients, LVEF improves and an ICD is not indicated. METHODS: Patients who received WCDs from November 2013 to November 2015 were identified and followed over a period of 2 years. Clinical variables were examined. The primary outcome was improvement in LVEF ≥35%. Predictors of outcome were determined using a multivariate logistic regression model. RESULTS: A total of 179 patients were followed. Median age was 65 (interquartile range [IQR]: 56, 73) years, 69.3% were men. Median baseline LVEF was 20% (IQR: 15, 30). LVEF improved ≥35% in 47.5% patients, with patients being younger (62 vs 68.5 years, P = .006), having lower blood urea nitrogen (BUN) (19 vs 24 mg/dL, P = .002), fewer left bundle branch block (LBBB 9.5% vs 25.8%, P = .004), shorter QRS duration (98 vs 112 ms, P < .001), and higher use of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (92.9% vs 74.4%, P = .001) compared to those without LVEF improvement. Absence of LBBB (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.11‐0.70), lower BUN (OR 0.13, 95% CI 0.02‐0.76), and ACEI/ARB use (OR 3.53, 95% CI 1.28‐9.69) were identified as independent predictors. Ventricular tachycardia/ventricular fibrillation was observed in three patients, all of whom received successful WCD shocks. CONCLUSION: Absence of LBBB, lower BUN, and ACEI/ARB use predicts LVEF improvement. WCDs help treat arrhythmic events. |
format | Online Article Text |
id | pubmed-7068066 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wiley Periodicals, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-70680662020-03-17 Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators Mehta, Nikhil A. Abdulsalam, Nashwa Kouides, Ruth Ahmed, Hamdy Atif, Raisa Shah, Abrar Taylor, Sarah Chuprun, Dmitry Huang, David Rao, Mohan Clin Cardiol Clinical Investigations OBJECTIVE: To identify predictors of left ventricular ejection fraction (LVEF) improvement in patients with newly detected cardiomyopathy using wearable cardioverter defibrillators (WCDs). BACKGROUND: WCDs are useful in preventing sudden cardiac death in patients with reduced LVEF <35% while awaiting implantable cardioverter defibrillator (ICD) placement. In many patients, LVEF improves and an ICD is not indicated. METHODS: Patients who received WCDs from November 2013 to November 2015 were identified and followed over a period of 2 years. Clinical variables were examined. The primary outcome was improvement in LVEF ≥35%. Predictors of outcome were determined using a multivariate logistic regression model. RESULTS: A total of 179 patients were followed. Median age was 65 (interquartile range [IQR]: 56, 73) years, 69.3% were men. Median baseline LVEF was 20% (IQR: 15, 30). LVEF improved ≥35% in 47.5% patients, with patients being younger (62 vs 68.5 years, P = .006), having lower blood urea nitrogen (BUN) (19 vs 24 mg/dL, P = .002), fewer left bundle branch block (LBBB 9.5% vs 25.8%, P = .004), shorter QRS duration (98 vs 112 ms, P < .001), and higher use of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (92.9% vs 74.4%, P = .001) compared to those without LVEF improvement. Absence of LBBB (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.11‐0.70), lower BUN (OR 0.13, 95% CI 0.02‐0.76), and ACEI/ARB use (OR 3.53, 95% CI 1.28‐9.69) were identified as independent predictors. Ventricular tachycardia/ventricular fibrillation was observed in three patients, all of whom received successful WCD shocks. CONCLUSION: Absence of LBBB, lower BUN, and ACEI/ARB use predicts LVEF improvement. WCDs help treat arrhythmic events. Wiley Periodicals, Inc. 2019-12-20 /pmc/articles/PMC7068066/ /pubmed/31860745 http://dx.doi.org/10.1002/clc.23295 Text en © 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Investigations Mehta, Nikhil A. Abdulsalam, Nashwa Kouides, Ruth Ahmed, Hamdy Atif, Raisa Shah, Abrar Taylor, Sarah Chuprun, Dmitry Huang, David Rao, Mohan Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators |
title | Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators |
title_full | Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators |
title_fullStr | Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators |
title_full_unstemmed | Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators |
title_short | Absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators |
title_sort | absence of left bundle branch block and blood urea nitrogen predict improvement in left ventricular ejection fraction in patients with cardiomyopathy and wearable cardioverter defibrillators |
topic | Clinical Investigations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068066/ https://www.ncbi.nlm.nih.gov/pubmed/31860745 http://dx.doi.org/10.1002/clc.23295 |
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