P1464A question of gender equality. Sex-related differences in survival after primary prevention implantable cardioverter-defibrillator implantation for dilated cardiomyopathy An analysis from POLKARD

OnBehalf

POLKARD Polish ICD Registry

Background

The protective effects of implantable cardioverter defibrillators (ICDs) in the primary prevention of sudden cardiac death of patients presenting with left ventricular (LV) systolic dysfunction are unequivocal. Nevertheless, female underrepresentation has been a consistent finding in all randomized controlled primary prevention ICD trials. Surprisingly, there is a vast body of literature on female primary prevention ICD patients exhibit a lower overall mortality.

Purpose

Therefore, we analyzed data from a large, nationwide POLKARD registry to evaluate the effect of sex on survival after primary prevention cardioverter-defibrillator implantation for dilated cardiomyopathy.

Methods

All patients enrolled in the Polish ICD Registry from 2008 to 2014 were identified. Patients were included in the study if they were designated as receiving an ICD for primary prevention of SCD after documented non-ischeamic cardiomyopathy. Kaplan-Meier survival analysis was used to assess all-cause mortality.

Results

Of the 964 ICD recipients, 241 (25%) were women (mean age of 64± 0,45 years). During a mean follow-up of 5,53 ± 2,48 years 32% of women and 42% of men died. Kaplan-Meier curve depicted a significantly lower mortality for women than for men (p = 0,05). The median survival time was 6,73 years (55 deaths per 1000 person-years) versus 6,37 years (78 deaths per 1000 person-years) for women and men, respectively.

Conclusions

In agreement with previous studies, our data indicate that primary prevention implantation rates for dilated cardiomyopathy are lower in women. However, the reasons are not entirely understood.

P1463Regional variation in survival rates among primary prevention implantable cardioverter-defibrillator recipients in Eastern and Northern Europe POLKARD Polish ICD Registry perspective

Funding Acknowledgements

None.

OnBehalf

POLKARD Polish ICD Registry

Objective

The findings of Danish Study to assess the efficiency of ICD in patients with non ischemic heart failure has recently raised questions about the current strategy of ICD implantation for the primary prevention of sudden cardiac death. POLKARD - Polish ICD Registry is a prospective, non-randomised, central registry of patients who are referred for an implantation of an ICD in Poland. The Registry contains prospectively collected follow-up data including mortality.

Purpose

To compare survival rates between Polish and Danish ‘real-world’ non-ischemic primary prevention cohorts.

Methods

Retrospective analysis of clinical characteristics and long-term follow-up of patients referred for primary prophylactic implantable cardioverter defibrillator (ICD) implantation in Poland between April 2008 and November 2014 was performed. The primary outcome of the trial was all-cause mortality. Results: The polish study cohort was large (964) as compared to Danish population randomized to receive ICD therapy (556). The median follow-up time in DANISH Study and Polish ICD Registry was 67,6 and 77 months, respectively. Compared with patients enrolled in the DANISH Study, patients in the Polish ICD Registry were age-similar. However, the polish study population was male-dominated. What is more, male gender was identified as a risk factor for long-term mortality in polish study population (p = 0.005). In the matched cohorts, there was difference in survival between DANISH Study and Polish ICD Registry patients (all-cause mortality rates: 21,6% - 44 events per 1000 person-years and 39,3% - 72 events per 1000 person-years, respectively).

Conclusions

Our findings imply that survival among patients who receive a primary prevention ICD for non-ischemic cardiomyopathy in clinical practice in Central Europe is different from Northern Europe.

P2878Higher all-cause mortality in patients with implanted dual-chamber cardioverter-defibrillators for secondary prevention: an analysis from the Polish ICD Registry

Background

In the Polish ICD Registry population secondary prevention recipients account for over 27%. Despite the evolution of indications for secondary prevention implantable cardioverter defibrillators (ICDs), recommendations regarding the use of ICDs for secondary prevention of sudden cardiac death (SCD) rely on information from a small number of randomized controlled trials that were performed decades ago, with mixed results. Moreover, research on the outcomes after implantations for secondary prevention of ICDs is limited. While dual-chamber devices offer theoretical advantage over single-chamber devices, dual-chamber ICDs (DC-ICDs) were announced not superior to single-chamber (SC-ICDs) in some research.

Purpose

Therefore, the aim of the study was to evaluate the all-cause mortality among patients from the Polish ICD Registry receiving either a single- or a dual-chamber device for secondary prevention in contemporary clinical practice.

Methods

All patients enrolled in the Polish ICD Registry from 1995 to 2016 were identified. Patients were included in the study if they were designated as receiving an ICD for secondary prevention of SCD after documented tachycardic arrest, sustained ventricular tachycardia (VT), or syncope. Kaplan-Meier survival analysis was used to assess all-cause mortality.

Results

In the study population of 3596 ICD recipients (mean age 69±12 years, 81% male, SC-ICD 61%, DC-ICD 39%), during mean follow-up of 79±43 months all-cause mortality rate was higher in the dual-chamber group than in the single chamber group, with a significant difference between the two groups as depicted in Kaplan-Meier curve (p<0,05). The median survival time was 98 months versus 110 months for SC and DC-ICD, respectively.

Conclusions

This study is the first to describe the characteristics of a national cohort of patients receiving a secondary prevention ICD in such a long follow-up period in contemporary practice. Implantation of a dual-chamber ICD was associated with higher all-cause mortality compared with single chamber devices.

Genetic engineering and molecular characterization of yeast strain expressing hybrid human-yeast squalene synthase as a tool for anti-cholesterol drug assessment

AIMS

The main objective of the study is molecular and biological characterization of the human-yeast hybrid squalene synthase (SQS), as a promising target for treatment of hypercholesterolaemia.

METHODS AND RESULTS

The human-yeast hybrid SQS, with 67% amino acids, including the catalytic site derived from human enzyme, was expressed in Saccharomyces cerevisiae strain deleted of its own SQS gene. The constructed strain has a decreased level of sterols compared to the control strain. The mevalonate pathway and sterol biosynthesis genes are induced and the level of triacylglycerols is increased. Treatment of the strain with rosuvastatin or zaragozic acid, two mevalonate pathway inhibitors, decreased the amounts of squalene, lanosterol and ergosterol, and up-regulated expression of several genes encoding enzymes responsible for biosynthesis of ergosterol precursors. Conversely, expression of the majority genes implicated in the biosynthesis of other mevalonate pathway end products, ubiquinone and dolichol, was down-regulated.

CONCLUSIONS

The S. cerevisiae strain constructed in this study enables to investigate the physiological and molecular effects of inhibitors on cell functioning.

SIGNIFICANCE AND IMPACT OF THE STUDY

The yeast strain expressing hybrid SQS with the catalytic core of human enzyme is a convenient tool for efficient screening for novel inhibitors of cholesterol-lowering properties.