"Good morning, my name is Dr Echivard, I'm working the University Hospital of Nancy and I am really happy to introduce this work entitled predicting heart failure events in patients with persistentleft ventricular dysfunction after acute myocardial infarction. This is an insight, a secondary analysis of the WICD MI trial.

I think the background really matters here. After mi some patients can suffer from left ventricular dysfunction and in these patients it's recommended to reassess LVF in 40 to 90 days. And for what reason? Not to stratify the heart failure risk, but to stratify the risk of sudden cardiac deaths and to determine whether they need an ICD implantation depending on how LVF evolves. And these patients may also benefit from a WICD setup during this waiting period.

So I think we can obviously say that in these patients the current management is primarily focused on preventing life threatening ventricular arrhythmia. However, in patients with persistent left ventricular dysfunction after the early post MI phase at time of ICD implantation, which is finally a common situation in current practice, in clinical practice we have so far no data regarding the heart failure risk and therefore how to satisfy this risk.

This is finally the second analysis of the WICD MI trial. The first article was published last year, last September in the European Heart journal. We analyzed 1015 patients from 41 French centers with first an acute myocardial infection, then a WICD set up at discharge because of a Leverage distension and finally a native deportation either in primary or in secondary prevention but which allow a persistent level dysfunction.

The follow up was the first care after ICG implantation and the Primary outcome was a composite outcome of heart failure events, namely heart failure hospitalization, left ventricular assist device implementation, heart transportation and death. And we aim first to quantify this risk during the first year after ICD implantation and then to stratifies this risk but stratified with a simple hypothesis that heart failure begets heart failure. We want to determine whether clinical heart failure features before the implementation could predict heart failure events after ICD implementation.

First of all, heart failure events in these patients with persistent vertical dysfunction is clearly frequent. It's frequent issue. The one year risk after ICD implementation of the primary outcome is 12.7%. The risk of heart failure hospitalization alone during this first year close to 10%. And what is striking, really interesting is to compare that to the risk of ventricular arrhythmia 5%. So the heart failure risk during this first year after acid duplication is almost twice as high as Ventricular arrhythmia risk.

Then we confirmed that HF begets HF using only four simple clinical heart failure features between MRI And ICD implementation could predict the risk of heart failure events after ICD implantation, namely cardiologic shock during MI requiring [indistinct] ECMO, congestive heart failure during MI requiring diuretics hospitalization for worsening heart failure during the WCD period and finally dyspnea, NYHA 3 or 4 at time of ICD implantation.

All these four features are independently associated with the primary outcome and finally we aim to build an easy to use score really an easy to use score in clinical practice one point for each of these four features and it enables to clearly distinguish low and high risk patients. Patients with 0.0 feature, 5% risk of primary outcome during the first year, patients with 3 or 4 features, 3 or 4 points 38% of risk during the first year of ICD implementation and this predict value remains across all secondary outcomes like heart failure hospitalization or deaths.

In terms of clinical applications it would probably improve the multidisciplinary management between arrhythmia specialists and heart failure specialists. It could help a rhythm specialist at time of ICD mplantations to identify high-risk with patients and to early refer them to heart failure specialists. Then and it's a little bit the same idea of timely referral, it could facilitate timely referrals to tertiary centers for advanced heart failure management and third finally it could improve the use of DDMT implementation.
Three key findings first in this patient with persistent left ventricular dysfunction after the early post-MI phase heart failure is clearly a frequent issue. Then using only four simple heart failure clinical feature between MRI and ICD implantations could predict the risk of heart failure events after ICD implantation, namely cardiologic discharge during MI, congestive heart failure during MI hospitalization for worsening heart failure during the WICD period and finally NYHA 3 or 4 dyspneas at time of ICD imputation and finally use this easy to use score this simple score to identify high risk patients and to, timely to early refer them to heart failure specialists or test service center for advanced heart failure management.

The next step was to validate this easy to use score in a larger cohort and to determine whether the use of this score in Clinical practice would improve patients endpoints.”