Publications [#198026] of Daniel B. Mark

Papers Published

1. LJ Gula, GJ Klein, AS Hellkamp, D Massel, AD Krahn, AC Skanes, R Yee, J Anderson, GW Johnson, JE Poole, DB Mark, KL Lee, GH Bardy, Ejection fraction assessment and survival: an analysis of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)., American heart journal, vol. 156 no. 6 (December, 2008), pp. 1196-200, ISSN 1097-6744 [doi]
   (last updated on 2011/11/29)

   Abstract:
   BACKGROUND: Ejection fraction (EF) is an important method of mortality prediction among cardiac patients, and has been used to identify the highest risk patients for enrollment in the defibrillator primary prevention trials. Evidence suggests that measures of EF by different imaging modalities may not be equivalent. In the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial), the type of imaging modality for EF assessment was not mandated. METHODS: Baseline assessment of EF was performed using either echocardiography, radionuclide angiography (RNA), or contrast angiography. Multivariable analysis using a Cox proportional hazards model was used to examine whether the modality of assessing EF affected the likelihood of survival. RESULTS: Among the 2,521 patients enrolled in SCD-HeFT, EF was measured by RNA in 616 (24%), echocardiography in 1,469 (58%), and contrast angiography in 436 (17%). Mean EF as measured by RNA was 25.1% +/- 6.9%; by echocardiography, 23.8 +/- 6.9%; and by angiography, 21.9 +/- 6.9%. These measures were significantly different (P < .001), and each pairwise comparison differed significantly (P < .001 for each). Multivariable analysis showed no significant difference in survival between patients enrolled based on RNA versus echocardiography (HR 1.06, 95% CI 0.88-1.28), RNA versus angiography (HR 1.25, 95% CI 0.97-1.62), or echocardiography versus angiography (HR 1.18, 95% CI 0.94-1.48). CONCLUSIONS: Among patients enrolled in SCD-HeFT, the distribution of ejection fractions measured by radionuclide angiography differed from those measured by echocardiography or contrast angiograms. Survival did not differ according to modality of EF assessment.

   Keywords:
   Aged • Amiodarone • Angiography • Anti-Arrhythmia Agents • Death, Sudden, Cardiac • Defibrillators, Implantable • Double-Blind Method • Echocardiography • Female • Heart Failure • Humans • Kaplan-Meier Estimate • Male • Middle Aged • Patient Selection • Predictive Value of Tests • Proportional Hazards Models • Radionuclide Angiography • Risk Assessment • Stroke Volume • Survival Analysis • epidemiology* • etiology • mortality* • physiology* • physiopathology • prevention & control • statistics & numerical data • therapeutic use • therapy