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This letter questions whether the mortality reduction associated with implantable cardioverter-defibrillators in non-ischaemic cardiomyopathy was influenced by residual confounders.
This commentary raises questions about potential residual confounders, such as non-cardiovascular comorbidities and heart failure severity, in a study evaluating ICD implantation and mortality in non-ischaemic cardiomyopathy.
This commentary refers to ‘Reduction in mortality from implantable cardioverter-defibrillators in non-ischaemic cardiomyopathy patients is dependent on the presence of left ventricular scar’, by S. Gutman et al., Eur Heart J 2019;40:542–550. We congratulate Gutman et al. for their timely work regarding risk stratification in non-ischaemic cardiomyopathy patients. We wonder whether residual confounders may have at least in part contributed to the association of implantable cardioverter-defibrillator (ICD) implantation and reduced mortality.1 Did important non-cardiovascular comorbidities like dementia, psychiatric disorders including depression, and frailty possibly influence the result2 since they impact on the decision to ICD implantation as well as the risk of death? Measurements of B-type natriuretic peptide (BNP) or NT-proBNP could help to more accurately adjust for heart failure severity.3 Further, we wonder whether you do have data correlating echocardiographic documentation of regional wall motion abnormalities with your MRI results since echocardiography would be much more readily available. Conflict of interest: Dr S.M.F. has nothing to declare. Dr C.S. has served on the speakers’ bureau for Medtronic, Biotronik, Boston Scientific, and Microport CRM and had scientific support from Medtronic, Biotronik, Boston Scientific, and Microport CRM. Dr C.M. has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union, the University of Basel, the University Hospital Basel, the Kommission für Technologie und Innovation, the Stiftung für kardiovaskuläre Forschung Basel, Abbott Laboratories, Beckman Coulter, Ortho Clinical Diagnostics, Quidel, Roche, Siemens, Singulex, Somalogic, Sphingotec, as well as speaker honoraria and consulting honoraria from Acon, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Indorsia, Novartis, Roche, Sanofi, Siemens, and Singulex.
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Frey et al. (2019) conducted a letter in Non-ischaemic cardiomyopathy. Implantable cardioverter-defibrillator (ICD) was evaluated on Mortality. This letter questions whether the mortality reduction associated with implantable cardioverter-defibrillators in non-ischaemic cardiomyopathy was influenced by residual confounders.
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