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Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=116). Intervention: Non-ischemic heart failure vs. Ischemic heart failure. Primary outcome: LVEF recovery to > 35% (OR 3.717, p=0.009).

Q: What does this research mean for the field?

Among primary prevention ICD recipients, left ventricular ejection fraction recovery to greater than 35% is significantly more frequent in patients with non-ischemic cardiomyopathy compared to ischemic cardiomyopathy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

doi:10.1016/s0870-2551(26)00301-x

August 1, 2026Revista Portuguesa de CardiologiaOpen Access

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Key result

Non-ischemic etiology linked to ~3.7-fold higher odds of LVEF recovery after primary prevention ICD.

OR 3.717
P=0.009
n=116

Why the study?

The indications for implantable cardioverter defibrillators in primary prevention remain unclear in certain clinical contexts, particularly regarding arrhythmic events and LVEF evolution.

How do arrhythmic events and LVEF evolution differ between ischemic and non-ischemic heart failure patients receiving ICDs for primary prevention?

Key Points

To evaluate arrhythmic events and left ventricular ejection fraction changes in heart failure patients receiving primary prevention implantable cardioverter-defibrillators amidst medical therapy optimization.
Conducted a retrospective cohort study of primary prevention implantable cardioverter-defibrillator recipients between 2015 and 2022 (N = 116; 85.3% male; mean age 62 ± 10.7 years).
Assessed changes in left ventricular ejection fraction, medical therapy (ARNi and SGLT2 inhibitors), arrhythmic shock occurrences, and overall mortality across ischemic and non-ischemic etiologies.
Patients with non-ischemic dysfunction demonstrated significant left ventricular ejection fraction recovery from 29% pre-implant to 33% at follow-up (p < 0.001, r = 0.617), with recovery to > 35% occurring more frequently than in ischemic patients (34.3% vs. 12.3%; OR 3.717; p = 0.009).
Appropriate shocks occurred in 29.3% of patients, with significantly higher rates in non-ischemic cardiomyopathy (p = 0.039), alcohol-related etiology (p = 0.025), and lower baseline ejection fraction (p = 0.008).
All-cause mortality was significantly elevated among patients with ischemic heart failure compared to non-ischemic heart failure (46.8% vs. 18.9%; p = 0.004).

Study Design

Type

Cohort (n=116)

Structured PICO

How do arrhythmic events and LVEF evolution differ between ischemic and non-ischemic heart failure patients receiving ICDs for primary prevention?

P

Population

116 patients (mean age 62 years, 14.7% female) with heart failure receiving an implantable cardioverter defibrillator for primary prevention between 2015 and 2022.

E

Exposure

Implantable cardioverter defibrillator (ICD) implantation for primary prevention along with pharmacological therapy optimization (including ARNi and SGLT2 inhibitors).

C

Comparator

Ischemic versus non-ischemic heart failure etiology.

O

Outcome

Arrhythmic events and the evolution of left ventricular ejection fraction (LVEF).

Main Result

Odds Ratio: 3.717

Absolute Event Rate: 34.3% vs 12.3%

p-value: p=0.009

In primary prevention ICD recipients, non-ischemic patients exhibit greater LVEF recovery following medical optimization but also experience higher rates of appropriate shocks compared to ischemic patients.

Limitations

Retrospective study design
Lack of large-scale research evaluating the potential futility of implanting high-energy devices

Implication

May guide etiology-specific LVEF expectations after primary prevention ICD; leaves open effects on shocks or mortality.

Abstract

Introduction: Heart failure (HF) affects millions of people worldwide and is associated with high morbidity and mortality.The left ventricular ejection fraction (LVEF) plays a key role in prognosis and treatment decisions.The implantable cardioverter defibrillator (ICD) reduces the risk of sudden death, however, there are clinical contexts where its indications remain unclear.This study evaluates arrhythmic events and the evolution of LVEF in patients with ICDs in primary prevention.Objectives: To assess arrhythmic events in patients with ICD, considering therapeutic optimization and to explore potential futility in various clinical scenarios.Methods: A retrospective study was conducted on ICD recipients for primary prevention between 2015 and 2022.Statistical analysis was performed using IBM ® SPSS ® Statistics, version 29.A p-value of less than 0.05 was considered statistically significant, with a 95% confidence interval.Results: A final sample of 116 patients was included after applying exclusion criteria, consisting of 99 men (85.3%) and 17 women (14.7%), with a mean age of 62 ± 10.7 years.A statistically significant recovery in LVEF was observed in patients with non-ischemic dysfunction (pré-ICD 29% vs. follow-up 33%; p < 0.001; r = 0.617).Recovery to > 35% was also more frequent in nonischemic group (34.3% vs. 12.3%; p = 0.009; OR 3.717).The use of ARNi and SGLT2 inhibitors significantly increased during follow-up.Appropriate shocks occurred in 29.3%, with higher rates patients with non-ischemic HF (p = 0.039), alcohol-related HF (p = 0.025), and those with a lower baseline LVEF (p = 0.008).Mortality was significantly higher in ischemic HF patients (46.8% vs. 18.9%; p = 0.004).Conclusions: This study provides new insights into the role of pharmacological therapy in LVEF recovery across different heart failure subtypes.As a retrospective study, it highlights the lack of large-scale research evaluating the potential futility of implanting high-energy devices in patients who might benefit more from the optimization of prognostic-modifying therapiesparticularly in non-ischemic patients, where this study observed greater potential for recovery. 2D.

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Cite This Study

A 2026 study conducted a cohort in Heart failure (n=116). Non-ischemic heart failure vs. Ischemic heart failure was evaluated on LVEF recovery to > 35% (OR 3.717, p=0.009). Among primary prevention ICD recipients, LVEF recovery >35% was significantly more frequent in patients with non-ischemic versus ischemic heart failure (34.3% vs. 12.3%; OR 3.717, P=0.009).

synapsesocial.com/papers/6ace6db8b52af824ab02bb36 https://doi.org/10.1016/s0870-2551(26)00301-x