March 5, 2022Open Access

Delayed Improvement of Left Ventricular Function in Newly Diagnosed Heart Failure Depends on Etiology—A PROLONG-II Substudy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Newly diagnosed heart failure with reduced ejection fraction (HFrEF) (n=382). Intervention: Wearable cardioverter-defibrillator (WCD) and optimal therapy vs. Patients with WCD indication for explantation of an infected ICD. Primary outcome: LVEF improvement beyond three months.

JMJohanna Müller‐LeisseMedizinische Hochschule Hannover JBJohanna BrunnMedizinische Hochschule Hannover CZChristos ZormpasMedizinische Hochschule Hannover

Key Result

Delayed LVEF recovery beyond three months occurred in patients with peripartum and dilated cardiomyopathy (improving 10±8% and 10±12%, respectively), but not in ischemic cardiomyopathy.

Study Design

Type

Cohort (n=382)

Multicenter

Structured PICO

Does the potential for delayed LVEF recovery beyond 3 months in newly diagnosed HFrEF patients depend on heart failure etiology?

Population

353 patients receiving a wearable cardioverter-defibrillator (WCD) for newly diagnosed HFrEF between 2012 and 2017 at a single center, and 29 patients with WCD indication for explantation of an infected ICD.

Intervention

Wearable cardioverter-defibrillator (WCD) and optimal therapy for a prolonged waiting period

Comparator

Patients with a distinct WCD indication (explantation of an infected ICD, n=29)

Outcome

Improvement of Left Ventricular Ejection Fraction (LVEF) from baseline to 3 months and beyond 3 monthssurrogate

Delayed LVEF recovery beyond 3 months in newly diagnosed HFrEF is etiology-dependent, occurring in PPCM and DCM but not ICM, which should inform the timing of primary preventive ICD implantation.

Abstract

In patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF), three months of optimal therapy are recommended before considering a primary preventive implantable cardioverter-defibrillator (ICD). It is unclear which patients benefit from a prolonged waiting period under protection of the wearable cardioverter-defibrillator (WCD) to avoid unnecessary ICD implantations. This study included all patients receiving a WCD for newly diagnosed HFrEF (n = 353) at our center between 2012 and 2017. Median follow-up was 2.7 years. From baseline until three months, LVEF improved in patients with all peripartum cardiomyopathy (PPCM), myocarditis, dilated cardiomyopathy (DCM), or ischemic cardiomyopathy (ICM). Beyond this time, LVEF improved in PPCM and DCM only (10 ± 8% and 10 ± 12%, respectively), whereas patients with ICM showed no further improvement. The patients with newly diagnosed HFrEF were compared to 29 patients with a distinct WCD indication, which is an explantation of an infected ICD. This latter group had a higher incidence of WCD shocks and poorer overall survival. All-cause mortality should be considered when deciding on WCD prescription. In patients with newly diagnosed HFrEF, the potential for delayed LVEF recovery should be considered when timing ICD implantation, especially in patients with PPCM and DCM.

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