Patients with non-ischemic systolic heart failure have increased mortality rates primarily due to death from progressive pump failure or SCD. SCD can be prevented by implantation of an ICD. However, the DANISH trial found no benefit of ICD implantation on all-cause mortality. Other and more accurate tools to risk stratify patients to ICD implantation are needed.
Age was the only pre-specified sub-group from the main DANISH trial with a significant interaction on all-cause mortality.
Late gadolinium enhancement seen on cardiac magnetic resonance imaging and the presence of right ventricular systolic dysfunction are recognized as important prognostic factors in patients with non-ischemic systolic heart failure.
The aim of the present thesis was to investigate the relationship between age, LGE, and right ventricular systolic dysfunction and effect of ICD implantation on all-cause mortality.
The main findings were I) ICD implantation only reduced mortality in the younger patients, probably due to a relative decreasing risk of SCD with increasing age, II) the presence of LGE on a CMR scan was a significant risk factor for all-cause mortality, though it could not be used to select patients with better efficacy of ICD implantation, and III) patients with biventricular heart failure had a worse prognosis than patients with normal right ventricular function, and ICD implantation reduced only all-cause mortality in patients with biventricular heart failure.
Place of employment
Department of Cardiology
Marie Bayer Elming, cand.med.
Date of defense
8th November 2019
Lars Køber (main)
Jens Jakob Thune