CRT-D May Reduce All-Cause Mortality in HFrEF Due to Nonischemic Cardiomyopathy

Heart failure, dilated cardiomyopathy
Heart failure, dilated cardiomyopathy
The researcher’ goal was to ascertain whether patients with heart failure with reduced ejection fraction due to nonischemic etiology who are eligible for cardiac resynchronization therapy can benefit from an ICD.

Patients with heart failure with reduced ejection fraction (HFrEF) due to nonischemic cardiomyopathy (NICM) had decreased all-cause mortality from cardiac resynchronization therapy with a cardioverter-defibrillator (CRT-D). These findings were published in JACC: Heart Failure.

Data from the COMPANION trial were analyzed for this post hoc study. Patients with ischemic cardiomyopathy (ICM; n=838) and NICM (n=682) who had HFrEF were randomly assigned to receive optimal pharmacologic therapy (OPT) alone (n=181; n=127), OPT with cardioverter (CRT; n=332; n=285), or OPT with CRT-D (n=325; n=270), respectively. Patients were assessed for all-cause mortality and clinical outcomes.

Patients had a median age of 66 (interquartile range [IQR], 58-74) years, 68% were men, and 41% had diabetes. Stratified by ICM and NICM status, patient groups differed significantly for all demographic characteristics (all P £.039) except systolic blood pressure and use of loop diuretics.

A total of 34% of the ICM and 25% of the NICM cohorts required hospitalization for heart failure (P <.0001) and 25% and 15% died (P <.0001), respectively.

Among all patients, all-cause mortality events occurred among 131 of the CRT and 105 of the CRT-D groups (P =.19). The difference in all-cause mortality did not differ among the ICM cohort (CRT: n=80 vs CRT-D: n=77; P =.87) but did among the NICM group (CRT: n=51 vs CRT-D: n=28; P =.015).

Deaths were cardiac-related (12.0% vs 19.0%; P =.0002), noncardiac-related (2.0% vs 3.8%), or vascular-related (0.2% vs 0.8%) among the NICM and ICM cohorts, respectively.

Decreased risk for all-cause mortality was associated with a CRT-D device among the NICM group (adjusted hazard ratio [aHR], 0.54; 95% CI, 0.34-0.86; P =.009), but not the ICM group (aHR, 1.05; 95% CI, 0.77-1.44; P =.75). There was evidence of an etiology by device interaction (P =.015).

Decreased risk for sudden cardiac death was associated with an CRT-D device among both the NICM (HR, 0.29; 95% CI, 0.11-0.78; P =.014) and ICM (HR, 0.42; 95% CI, 0.22-0.82; P =.012) cohorts.

These findings suggest that CRT-D, and not CRT-P, reduced all-cause mortality among patients with HFrEF due to NICM who were eligible for CRT.  The authors noted that these findings did not support the use of ICD therapy in patients with NICM who do not meet criteria for CRT.


Doran B, Mei C, Varosy PD, et al. The addition of a defibrillator to resynchronization therapy decreases mortality in patients with nonischemic cardiomyopathy. JACC Heart Fail. Published online May 5, 2021. doi:10.1016/j.jchf.2021.02.013