Relations between heart failure, ejection fraction, arrhythmia suppression and mortality: analysis of the Cardiac Arrhythmia Suppression Trial

Clinical Trial Center, University of Washington, Seattle 98105, USA.

OBJECTIVES. We studied the relations between heart failure, ejection fraction, arrhythmia suppression and mortality. BACKGROUND. Both left ventricular ejection fraction and functional class of heart failure are strongly associated with mortality after acute myocardial infarction. Both are also related to the presence of ventricular arrhythmias and have been identified as factors related to the ability to suppress ventricular arrhythmias. Little has been reported about the relations between these two factors and arrhythmia suppression or mortality. METHODS. Baseline data from the Cardiac Arrhythmia Suppression Trial were used to define several categories of heart failure and to relate both the resulting categories and ejection fraction to arrhythmia suppression and mortality using logistic and survival regression analytic methodologies. RESULTS. Regardless of the prospective baseline definition of heart failure used, the data consistently showed that heart failure was a more powerful predictor of subsequent congestive heart failure events and arrhythmia suppression and was equally powerful in predicting death. However, each variable provided incremental information when included in the prediction model. Heart failure and ejection fraction appeared to be independent predictors of death. Interactions were observed: A low ejection fraction was more predictive of failure of arrhythmia suppression in patients with than without evidence of heart failure before or at baseline; a low ejection fraction was more predictive of subsequent congestive heart failure events in patients without than with evidence of heart failure before or at baseline. CONCLUSIONS. Although heart failure as a prognostic feature appears to be somewhat superior to ejection fraction, both are powerful predictors of arrhythmia suppression and cardiac events in patients with ventricular arrhythmia after myocardial infarction. Each provides incremental prediction.

This article has been cited by other articles:

				P. Pascale, J. Schlaepfer, M. Oddo, M.-D. Schaller, P. Vogt, and M. Fromer Ventricular arrhythmia in coronary artery disease: limits of a risk stratification strategy based on the ejection fraction alone and impact of infarct localization Europace, December 1, 2009; 11(12): 1639 - 1646. [Abstract] [Full Text] [PDF]

				M. J. Silka and Y. Bar-Cohen Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?: Patients With Congenital Heart Disease and a Systemic Ventricular Ejection Fraction Less Than 30% Should Undergo Prophylactic Implantation of an Implantable Cardioverter Defibrillator Circ Arrhythm Electrophysiol, October 1, 2008; 1(4): 298 - 306. [Full Text] [PDF]

				E. Aliot and J. N. Ruskin Controversies in ablation of atrial fibrillation Eur. Heart J. Suppl., September 1, 2008; 10(suppl_H): H32 - H54. [Abstract] [Full Text] [PDF]

				C. M. Pratt Three decades of clinical trials with beta-blockers: The contribution of the CAPRICORN trial and the effect of carvedilol on serious arrhythmias J. Am. Coll. Cardiol., February 15, 2005; 45(4): 531 - 532. [Full Text] [PDF]

				F. K Shieh, E. Kotlyar, and F. Sam Aldosterone and cardiovascular remodelling: focus on myocardial failure Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1): 3 - 13. [Abstract] [PDF]

				J. R de Groot, C. A Schumacher, A. O Verkerk, A. Baartscheer, J. W.T Fiolet, and R. Coronel Intrinsic heterogeneity in repolarization is increased in isolated failing rabbit cardiomyocytes during simulated ischemia Cardiovasc Res, September 1, 2003; 59(3): 705 - 714. [Abstract] [Full Text] [PDF]

				J. P. Curtis, S. I. Sokol, Y. Wang, S. S. Rathore, D. T. Ko, F. Jadbabaie, E. L. Portnay, S. J. Marshalko, M. J. Radford, and H. M. Krumholz The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure J. Am. Coll. Cardiol., August 20, 2003; 42(4): 736 - 742. [Abstract] [Full Text] [PDF]

				A. E. Buxton, K. L. Lee, G. E. Hafley, D. G. Wyse, J. D. Fisher, M. H. Lehmann, L. A. Pires, M. R. Gold, D. L. Packer, M. E. Josephson, et al. Relation of Ejection Fraction and Inducible Ventricular Tachycardia to Mode of Death in Patients With Coronary Artery Disease: An Analysis of Patients Enrolled in the Multicenter Unsustained Tachycardia Trial Circulation, November 5, 2002; 106(19): 2466 - 2472. [Abstract] [Full Text] [PDF]

				T. Shirayama, H. Shiraishi, S. Yoshida, Y. Matoba, H. Imai, and M. Nakagawa Atrial fibrillation threshold predicted long-term efficacy of pharmacological treatment of patients without structural heart disease Europace, January 1, 2002; 4(4): 383 - 389. [Abstract] [PDF]

				G. Cice, E. Tagliamonte, L. Ferrara, and A. Iacono Efficacy of carvedilol on complex ventricular arrhythmias in dilated cardiomyopathy: double-blind, randomized, placebo-controlled study Eur. Heart J., August 1, 2000; 21(15): 1259 - 1264. [Abstract] [PDF]

				R. D. Anderson, E. M. Ohman, D. R. Holmes Jr., R. A. Harrington, G. W. Barsness, N. M. Wildermann, H. R. Phillips, E. J. Topol, and R. M. Califf Prognostic value of congestive heart failure history in patients undergoing percutaneous coronary interventions J. Am. Coll. Cardiol., October 1, 1998; 32(4): 936 - 941. [Abstract] [Full Text] [PDF]

				F. E. Marchlinski Predicting Arrhythmic Death : A Plea for Standardized Reporting Techniques and Data Based on Continuous Electrocardiographic Monitoring Circulation, September 16, 1997; 96(6): 1713 - 1716. [Full Text]