Key result
Larger baseline LVEDD is linked to ~11% higher device implantation odds per mm in HFrEF.
Why the study?
Real-world data on left ventricular ejection fraction recovery and the need for ICD/CRT-D implantation under contemporary quadruple guideline-directed therapy in HFrEF are limited.
Does contemporary quadruple guideline-directed therapy improve LVEF recovery and reduce the need for ICD/CRT-D implantation in patients with HFrEF?
Cohort (n=65)
Not documented
No
Does contemporary quadruple guideline-directed therapy improve LVEF recovery and reduce the need for ICD/CRT-D implantation in patients with HFrEF?
Contemporary quadruple medical therapy is associated with significant LVEF recovery at 3 months in real-world HFrEF patients, confirming the value of deferring ICD/CRT-D implantation to allow for reverse remodeling.
Answers are grounded in this paper and cite their sources.
LVEF recovery on quadruple therapy was associated with device decisions in this HFrEF cohort; leaves open optimal deferral timing and LVEDD thresholds for prospective trials.
Background Guidelines advise deferring primary-prevention implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) implantation until left ventricular ejection fraction (LVEF) is reassessed after at least three months of medical therapy in heart failure with reduced ejection fraction (HFrEF). Real-world data under contemporary quadruple therapy are limited.Research design and methods Retrospective single-center cohort of 65 HFrEF patients (Coburg Hospital, Germany; October 2023–December 2024), prescribed beta-blocker, angiotensin receptor–neprilysin inhibitor, mineralocorticoid receptor antagonist and SGLT2 inhibitor (all four in 92%; doses not recorded). LVEF was measured by echocardiography (TTE) and cardiac magnetic resonance (CMR) at baseline and ~3 months; reader blinding was not documented. Device implantation followed guideline criteria. Patients with severe arrhythmic events were excluded.Results Twenty-nine patients (44.6%) received a device. LVEF rose on TTE (28.0→36.0%) and CMR (26.3→38.5%) (both p < 0.001), mainly without device implantation (TTE +13.0 vs + 1.5 points). Larger baseline left ventricular end-diastolic diameter was associated with smaller recovery (β = −0.41, p = 0.006) and device implantation (odds ratio 1.11/mm, 95% CI 1.01–1.22). Adverse events were not recorded.Conclusions LVEF recovery was common, and associations are consistent with disease severity. Findings are hypothesis-generating; absent dose, arrhythmic-outcome and wearable-defibrillator data and the selected cohort limit generalizability.
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Ajmi et al. (2026) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=65). Contemporary quadruple guideline-directed therapy was evaluated on Device implantation (ICD/CRT-D) and its association with baseline left ventricular end-diastolic diameter (OR 1.11, 95% CI 1.01-1.22). Among HFrEF patients on quadruple therapy, LVEF improved significantly, while 44.6% received an ICD/CRT-D; larger baseline LVEDD was associated with device implantation (OR 1.11/mm; 95% CI 1.01-1.22).
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