SHBC1112

W.S.J.ONG¹, K.K.I.CHUNG¹ 

Tan Tock Seng Hospital¹

Heart failure carries significant mortality and progressive improvement of therapeutic regimens improves it. Mortality benefit of automated implantable cardioverter-defibrillators (AICD) in non-ischaemic cardiomyopathy (NICMP) patients is less clear. DEFINITE trial subgroup analysis favoured medical treatment for females.

386 patients with heart failure and reduced left ventricular ejection fraction (LVEF<40%) due to NICMP, all had coronary angiogram to exclude significant coronary artery disease (>70% stenosis).

Mean age 62.45 ± 13.96 years, male patients 277 (72%). Male and female patients mean age 60.79 ± 13.55 and 66.69 ± 14.13 years respectively. Patients with diabetes mellitus 39%, hypertension 76%, atrial fibrillation 32%, stroke 7%. LDL 2.71 ± 1.16 mmol/l, HbA1c 6.61 ± 1.65%, baseline creatinine 99.63 ± 37.53. Patients taking ivabradine 10%, beta-blocker 90%, angiotensin inhibitors/angiotensin receptor blocker 66%, sacubitril/valsartan 30%, spironolactone 64%, SGLT-2 inhibitor 10%. Mean follow-up duration 5.82 ± 3.92 years. There were 35 deaths (9%, 1.56% death/ year, 11 females, 24 males). LVEF increased from 22.40 ± 8.49 to 36.78 ± 14.54% (p<0.005). 164 patients (42%) LVEF increased to or more than 35%. 36 patients (9%) received device therapy (AICD/CRTD), 19% secondary prevention, 81% primary prevention. Mean time from NICMP diagnosis to appropriate device therapy for VT/VT storms was 9.49 ± 2.85 years, 16/20 patients (80%) were males (p=0.048).

Progressive improvement of therapeutic regimens improves mortality by improving LVEF. Arrhythmic risk is higher in males than females. Mean time from NICMP diagnosis to appropriate device therapy for VT/VT storms was 9.49 ± 2.85 years, suggesting arrhythmic risk with disease progression.