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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIs Ejection Fraction Alone a Sufficient Indication for an Implantable Cardioverter Device?\u003C\/p\u003E\n            \u003Cp id=\u0022p-2\u0022\u003EYES. \u201cEjection fraction (EF) alone is sufficient indication for ICD placement,\u201d said Helmut U. Klein, MD, Chief, Division of Cardiology, University Hospital, Magdeburg, Germany.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EIs Ejection Fraction Alone a Sufficient Indication for an Implantable Cardioverter Device?\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EYES. \u201cEjection fraction (EF) alone is sufficient indication for ICD placement,\u201d said Helmut U. Klein, MD, Chief, Division of Cardiology, University Hospital, Magdeburg, Germany.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003E\u201cIn most studies, risk parameters were studied in patients with lowered EFs,\u201d said Dr. Klein. \u201cThis means that most of what we know about when and why to implant ICDs is in patients with low EFs\u2014not the general population.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDr. Klein contended that the weight of evidence along with guidelines from most expert groups tell us that earlier intervention for preventing SCD is warranted in selected patients. \u201cAnd do we really have more or better parameters for selecting these patients than LVEF?\u201d he asked.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EIn Dr. Klein\u0027s view, none of the currently known and tested risk factors or criteria aside from EF have sufficient sensitivity or predictive value to be used alone as ICD indications.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003E\u201cEF is also easy to assess, quick, and cost-effective,\u201d Dr. Klein noted. \u201cAs long as there\u0027s no better risk criteria for ICDs, we must go with EF.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003ENO. \u201cDr. Klein\u0027s argument is precisely why we should not rely on EF alone as a sole indicator for ICD placement,\u201d said Andrea Russo, MD, Director, Electrophysiology Laboratory, Penn Presbyterian Medical Center. \u201cThe very fact that key studies don\u0027t look at EF alone means we should not use EF measurement in isolation in making clinical decisions,\u201d she said.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EDr. Russo noted that in a succession of key clinical trials (MADIT, MADIT-II, MUSTT, SCD-HEFT), EF \u0026lt;30\u201340% was a principal criteria, \u201cbut never the only criteria. And none of these trials were designed to evaluate EF alone. Therefore, we do not have data that truly evaluates EF as a single criteria for ICD.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EDr. Russo also observed that using EF as the only risk stratification tool might put patients at risk unnecessarily, noting costs and risks in patients who may be poor candidates for implantation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EIn citing the facts that SCD and mortality are impacted by multiple factors\u2014not solely by EF\u2014and that some patients with normal EFs go on to SCD, Dr. Russo reiterated her contention that using EF alone as a guide to ICD placement is inadequate.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003E\u201cEF alone cannot identify all patients at risk all the time,\u201d she said. \u201cIt is not universal and it is not a panacea in making the ICD decision.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003E\n            \u003Cstrong\u003EComment:\u003C\/strong\u003E Conversely, not all patients with low EF are at high risk for SCD. There clearly is a need for more specific tools for risk stratification.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/21\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-552364154\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/21\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/21\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/21\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16091\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/1\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl5q1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl5q1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}