Aims

The left ventricular ejection fraction (LVEF) is the most common used marker in patients with congestive heart failure and a reduced LVEF is the main cause of ICD-Implantation in primary prevention. The left ventricular global function index (LVGFI) is a marker that includes myocardial hypertrophy as well as the cardiac output and has already shown predictive value in several cohorts. Our goal is the evaluation of the prognostic value of the LVGFI measured by MRI in primary prevention ICD patients.

Methods

117 patients with cardiac MRI prior to the ICD implantation in primary prevention were included (mean age 54± 12 years old; 81% male). The LVGFI was calculated based on the MRI data and a cutoff-value was determined via Youden-Index. Patients were followed regularly in our clinic. Data regarding the occurrence of rehospitalization due to congestive heart failure or mortality were collected.

Results

Follow up went on for 64 months in median. The cut off value for LVGFI (12,7%) to dichotomise the study cohort was determined via Youden index.. The cohort with higher LVGFI consisted of 72 patients and the cohort with lower LVGFI included 45 patients. The LVGFI correlated significantly with the LVEF (r=0.679, p<0.001). In Kaplan–Meier analysis, a lower LVGFI (<12.7%) was associated with a higher rate of mortality and rehospitalisation due to congestive heart failure (21/45 vs. 15/72; p< 0.001). In multivariate Cox-regression analysis a lower LVGFI could be shown as independent and significant predictor for mortality as well as rehospitalisation (p= 0.001; HR= 0.911 (0.86-0.96), next to older age. The LVEF measured by MRI or echocardiography was neither an independent predictor nor was sex or the presence of CAD or chronic renal failure.

Conclusion

LVGFI was shown as an independent predictor for adverse events in primary prevention ICD patients, and thus could identify a high-risk collective among these patients. But further studies are needed to evaluate the prognostic value of the LVGFI.