PMID- 19884110
OWN - NLM
STAT- MEDLINE
DCOM- 20100603
LR  - 20100330
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 96
IP  - 7
DP  - 2010 Apr
TI  - Incidence of left ventricular function improvement after primary prevention ICD 
      implantation for non-ischaemic dilated cardiomyopathy: a multicentre experience.
PG  - 510-5
LID - 10.1136/hrt.2009.178061 [doi]
AB  - BACKGROUND: The SCD-HeFT study demonstrated a benefit of primary prevention 
      implantable cardioverter-defibrillator (ICD) implantation in patients with 
      non-ischaemic dilated cardiomyopathy (NIDCM). However, NIDCM may improve 
      spontaneously, even after waiting 6-9 months on optimal medical treatment. 
      OBJECTIVE: To assess the incidence of left ventricular (LV) function improvement 
      in patients receiving primary prevention ICDs for NIDCM. METHODS: All patients 
      with NIDCM receiving primary prevention ICDs (non-cardiac resynchronisation 
      therapy) from 2005 to the present at our institutions were retrospectively 
      studied. All patients had NIDCM confirmed by a lack of significant stenoses on 
      coronary angiography, a lack of significant valvular abnormalities on echo, and 
      LV dysfunction with ejection fraction (EF) <35%. All patients had to have had a 
      diagnosis of NIDCM for at least 9 months and be receiving optimal medical 
      treatment for at least 3 months before implant according to the guidelines. All 
      patients had at least New York Heart Association (NYHA) II symptoms. Baseline and 
      follow-up EF was documented by quantitative echo and/or multi-gated acquisition 
      scan. RESULTS: 332 patients were identified by a database search. Patients were 
      aged 67+/-11 years, 75% of them were male, NYHA 2.3+/-0.7, with EF 25+/-13%, and 
      LV diastolic diameter 61+/-10 mm. Time from initial NIDCM diagnosis to implant 
      was 11+/-6 months and duration of medical treatment before implant was 8+/-5 
      months. Treatment at the time of implant included ACE inhibitors or ARBs (85%), 
      beta blockers (77%), spironolactone (53%), loop diuretic (63%) and digoxin (50%). 
      Repeat EF assessment was available in 309/332 (93%) 8+/-6 months after implant. 
      EF improved to >35% in 37/309 (12%) patients. Patients who improved had a shorter 
      time from diagnosis to implant (9+/-3 vs 13+/-5 months respectively, p=0.03). No 
      other significant predictors were identified for patients with improved EF. 
      CONCLUSIONS: In spite of following guidelines for implantation of primary 
      prevention ICDs in patients with NIDCM, a substantial number of patients (12%) 
      experience improvement in LV function to levels above those recommended for ICD 
      implant. A shorter time from diagnosis to implant may predict post-implant 
      improvement.
FAU - Verma, Atul
AU  - Verma A
AD  - Southlake Heart Rhythm Program, 105-712 Davis Drive, Newmarket, Ontario, Canada. 
      atul.verma@utoronto.ca
FAU - Wulffhart, Zaev
AU  - Wulffhart Z
FAU - Lakkireddy, Dhanunjaya
AU  - Lakkireddy D
FAU - Khaykin, Yaariv
AU  - Khaykin Y
FAU - Kaplan, Alexander
AU  - Kaplan A
FAU - Sarak, Bradley
AU  - Sarak B
FAU - Biria, Mazda
AU  - Biria M
FAU - Pillarisetti, Jayasree
AU  - Pillarisetti J
FAU - Bhat, Pradeep
AU  - Bhat P
FAU - Di Biase, Luigi
AU  - Di Biase L
FAU - Constantini, Otto
AU  - Constantini O
FAU - Quan, Kara
AU  - Quan K
FAU - Natale, Andrea
AU  - Natale A
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20091101
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
SB  - IM
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Aged
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Cardiomyopathy, Dilated/*prevention & control
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Humans
MH  - Male
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*therapy
EDAT- 2009/11/04 06:00
MHDA- 2010/06/04 06:00
CRDT- 2009/11/04 06:00
PHST- 2009/11/04 06:00 [entrez]
PHST- 2009/11/04 06:00 [pubmed]
PHST- 2010/06/04 06:00 [medline]
AID - hrt.2009.178061 [pii]
AID - 10.1136/hrt.2009.178061 [doi]
PST - ppublish
SO  - Heart. 2010 Apr;96(7):510-5. doi: 10.1136/hrt.2009.178061. Epub 2009 Nov 1.