Atlas of Cardiac Innervation by Vasken Dilsizian & Jagat Narula

Author:Vasken Dilsizian & Jagat Narula
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Figure 6-2.(a) Quantitative relationship between drug/device effects on ejection fraction (EF) and mortality: each data point represents a placebo-corrected change in EF from an individual remodeling trial plotted against the mortality odds ratio (OR) for the specific therapy. Color-coded mortality effect based on meta-analysis of published data. Interventions were classified as favorable (blue circles) if the upper limit of the 95 % confidence interval (CI) of the OR for death from the mortality trials was less than 1, neutral (black circles) if the 95 % CI crossed 1, and adverse (red circles) if the lower limit of the 95 % CI was greater than 1. There was a significant correlation between short-term therapeutic effect on LVEF and longer-term therapeutic effect on mortality (ρ = −0.51, P < 0.001). Remodeling data were derived from analysis of 86 randomized controlled trials (RCTs) of 25 interventions involving 19,092 patients. (b) Predicted probability of a categorical mortality outcome based on drug/device effect on EF: the lines represent the likelihood of a categorical mortality outcome based on an intervention's trial-level effect on EF compared with placebo (unadjusted, weighted, ordered logistic regression). Color-coded mortality effect based on meta-analysis of published data. Definition of mortality effect for a given intervention is as described in A. The graph suggests that if the mean change in EF is 10 % in the short-term studies, the probabilities that the long-term mortality studies will be significantly favorable (blue line), neutral (black line), or significantly unfavorable (red line) are approximately 85 %, 15 %, and 1 %, respectively. As such, the degree of drug/device-induced reverse remodeling as reflected by EF change is a quantitative marker of favorable prognosis (Adapted from Kramer et al. [4]).

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