Nonischemic Heart Transplant Candidates Get No ICD Benefit

BOSTON — Patients with nonischemic cardiomyopathy who received an implantable cardioverter defibrillator did not have a survival benefit while listed as status 2 for a potential heart transplant, compared with patients who did not have an implantable defibrillator, based on records from more than 2,500 U.S. patients who were listed during 2000–2005.

In contrast, patients with ischemic cardiomyopathy who had an implantable cardioverter defibrillator (ICD) while listed as status 2 for a heart transplant during the same period had a significant 6% absolute survival advantage compared with patients without an ICD during the same period, Dr. Katherine Lietz reported at the annual meeting of the International Society for Heart and Lung Transplantation.

The reason for this difference in the impact of ICDs on survival based on whether a patient's cardiomyopathy had an ischemic or nonischemic etiology is not clear, she said. In addition, this finding should not be viewed as a reason to not place ICDs in patients with nonischemic cardiomyopathy, said Dr. Lietz, a transplant cardiologist at Columbia University in New York. Rather, the finding suggests that more research should be done to identify the determinants of survival in patients with nonischemic cardiomyopathy who are awaiting a heart transplant.

Her analysis focused on U.S. patients listed with the United Network for Organ Sharing as status 2 patients, defined as those who meet general criteria for a heart transplant, but are not “high urgency” status 1 patients.

During the period studied, use of ICDs in status 2 patients jumped more than twofold, rising from 37% in 2005 to 77% of listed status 2 patients in 2005, Dr. Lietz said. A total of 6,201 patients were listed as status 2 for a heart transplant in this period: 3,448 patients with ischemic-etiology cardiomyopathy and 2,753 patients with a nonischemic etiology. The vast majority (98%) of these patients who received an ICD had it implanted before they were listed for a heart transplant.

The 3-year survival rate of all patients with ischemic cardiomyopathy who had an ICD was 84%, compared with 76% among patients who did not receive an ICD. The researchers then ran the same analysis only on patients who remained on the list and did not receive a donated heart. In this subgroup, the 3-year survival rate with an ICD was 73.6%, and without an ICD it was 67.4%, a significant difference.

The 6.2% absolute improvement in survival over 3 years linked with ICD use was comparable with the survival benefit seen with ICD use in the Sudden Cardiac Death Heart Failure Trial (SCD-HFT), Dr. Lietz noted.

In contrast, among all patients with nonischemic cardiomyopathy who were listed as status 2, the 3-year survival rate with an ICD was 79.8%, compared with 81.2% among patients without an ICD, a “surprising” finding, said Dr. Lietz. This unexpected disparity remained among those who remained listed without a new heart. The survival rate was 65.7% with an ICD and 74.5% without an ICD, a difference that was not statistically significant, Dr. Lietz said.

Presence of an ICD did not affect the 3-year survival rate in status 2 patients with nonischemic cardiomyopathy. DR. LIETZ

BOSTON — Patients with nonischemic cardiomyopathy who received an implantable cardioverter defibrillator did not have a survival benefit while listed as status 2 for a potential heart transplant, compared with patients who did not have an implantable defibrillator, based on records from more than 2,500 U.S. patients who were listed during 2000–2005.

In contrast, patients with ischemic cardiomyopathy who had an implantable cardioverter defibrillator (ICD) while listed as status 2 for a heart transplant during the same period had a significant 6% absolute survival advantage compared with patients without an ICD during the same period, Dr. Katherine Lietz reported at the annual meeting of the International Society for Heart and Lung Transplantation.

The reason for this difference in the impact of ICDs on survival based on whether a patient's cardiomyopathy had an ischemic or nonischemic etiology is not clear, she said. In addition, this finding should not be viewed as a reason to not place ICDs in patients with nonischemic cardiomyopathy, said Dr. Lietz, a transplant cardiologist at Columbia University in New York. Rather, the finding suggests that more research should be done to identify the determinants of survival in patients with nonischemic cardiomyopathy who are awaiting a heart transplant.

Her analysis focused on U.S. patients listed with the United Network for Organ Sharing as status 2 patients, defined as those who meet general criteria for a heart transplant, but are not “high urgency” status 1 patients.

During the period studied, use of ICDs in status 2 patients jumped more than twofold, rising from 37% in 2005 to 77% of listed status 2 patients in 2005, Dr. Lietz said. A total of 6,201 patients were listed as status 2 for a heart transplant in this period: 3,448 patients with ischemic-etiology cardiomyopathy and 2,753 patients with a nonischemic etiology. The vast majority (98%) of these patients who received an ICD had it implanted before they were listed for a heart transplant.

The 3-year survival rate of all patients with ischemic cardiomyopathy who had an ICD was 84%, compared with 76% among patients who did not receive an ICD. The researchers then ran the same analysis only on patients who remained on the list and did not receive a donated heart. In this subgroup, the 3-year survival rate with an ICD was 73.6%, and without an ICD it was 67.4%, a significant difference.

The 6.2% absolute improvement in survival over 3 years linked with ICD use was comparable with the survival benefit seen with ICD use in the Sudden Cardiac Death Heart Failure Trial (SCD-HFT), Dr. Lietz noted.

In contrast, among all patients with nonischemic cardiomyopathy who were listed as status 2, the 3-year survival rate with an ICD was 79.8%, compared with 81.2% among patients without an ICD, a “surprising” finding, said Dr. Lietz. This unexpected disparity remained among those who remained listed without a new heart. The survival rate was 65.7% with an ICD and 74.5% without an ICD, a difference that was not statistically significant, Dr. Lietz said.

Presence of an ICD did not affect the 3-year survival rate in status 2 patients with nonischemic cardiomyopathy. DR. LIETZ

BOSTON — Patients with nonischemic cardiomyopathy who received an implantable cardioverter defibrillator did not have a survival benefit while listed as status 2 for a potential heart transplant, compared with patients who did not have an implantable defibrillator, based on records from more than 2,500 U.S. patients who were listed during 2000–2005.

In contrast, patients with ischemic cardiomyopathy who had an implantable cardioverter defibrillator (ICD) while listed as status 2 for a heart transplant during the same period had a significant 6% absolute survival advantage compared with patients without an ICD during the same period, Dr. Katherine Lietz reported at the annual meeting of the International Society for Heart and Lung Transplantation.

The reason for this difference in the impact of ICDs on survival based on whether a patient's cardiomyopathy had an ischemic or nonischemic etiology is not clear, she said. In addition, this finding should not be viewed as a reason to not place ICDs in patients with nonischemic cardiomyopathy, said Dr. Lietz, a transplant cardiologist at Columbia University in New York. Rather, the finding suggests that more research should be done to identify the determinants of survival in patients with nonischemic cardiomyopathy who are awaiting a heart transplant.

Her analysis focused on U.S. patients listed with the United Network for Organ Sharing as status 2 patients, defined as those who meet general criteria for a heart transplant, but are not “high urgency” status 1 patients.

During the period studied, use of ICDs in status 2 patients jumped more than twofold, rising from 37% in 2005 to 77% of listed status 2 patients in 2005, Dr. Lietz said. A total of 6,201 patients were listed as status 2 for a heart transplant in this period: 3,448 patients with ischemic-etiology cardiomyopathy and 2,753 patients with a nonischemic etiology. The vast majority (98%) of these patients who received an ICD had it implanted before they were listed for a heart transplant.

The 3-year survival rate of all patients with ischemic cardiomyopathy who had an ICD was 84%, compared with 76% among patients who did not receive an ICD. The researchers then ran the same analysis only on patients who remained on the list and did not receive a donated heart. In this subgroup, the 3-year survival rate with an ICD was 73.6%, and without an ICD it was 67.4%, a significant difference.

The 6.2% absolute improvement in survival over 3 years linked with ICD use was comparable with the survival benefit seen with ICD use in the Sudden Cardiac Death Heart Failure Trial (SCD-HFT), Dr. Lietz noted.

In contrast, among all patients with nonischemic cardiomyopathy who were listed as status 2, the 3-year survival rate with an ICD was 79.8%, compared with 81.2% among patients without an ICD, a “surprising” finding, said Dr. Lietz. This unexpected disparity remained among those who remained listed without a new heart. The survival rate was 65.7% with an ICD and 74.5% without an ICD, a difference that was not statistically significant, Dr. Lietz said.

Presence of an ICD did not affect the 3-year survival rate in status 2 patients with nonischemic cardiomyopathy. DR. LIETZ