Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy: A multicentre experience

Atul Verma, Zaev Wulffhart, Dhanunjaya Lakkireddy, Yaariv Khaykin, Alexander Kaplan, Bradley Sarak, Mazda Biria, Jayasree Pillarisetti, Pradeep Bhat, Luigi Di Biase, Otto Constantini, Kara Quan, Andrea Natale

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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%), β 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.

Original languageEnglish (US)
Pages (from-to)510-515
Number of pages6
JournalHeart
Volume96
Issue number7
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Implantable Defibrillators
Dilated Cardiomyopathy
Primary Prevention
Left Ventricular Function
Incidence
Left Ventricular Dysfunction
Coronary Angiography
Pathologic Constriction
Guidelines
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy : A multicentre experience. / Verma, Atul; Wulffhart, Zaev; Lakkireddy, Dhanunjaya; Khaykin, Yaariv; Kaplan, Alexander; Sarak, Bradley; Biria, Mazda; Pillarisetti, Jayasree; Bhat, Pradeep; Di Biase, Luigi; Constantini, Otto; Quan, Kara; Natale, Andrea.

In: Heart, Vol. 96, No. 7, 04.2010, p. 510-515.

Research output: Contribution to journalArticle

Verma, A, Wulffhart, Z, Lakkireddy, D, Khaykin, Y, Kaplan, A, Sarak, B, Biria, M, Pillarisetti, J, Bhat, P, Di Biase, L, Constantini, O, Quan, K & Natale, A 2010, 'Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy: A multicentre experience', Heart, vol. 96, no. 7, pp. 510-515. https://doi.org/10.1136/hrt.2009.178061
Verma, Atul ; Wulffhart, Zaev ; Lakkireddy, Dhanunjaya ; Khaykin, Yaariv ; Kaplan, Alexander ; Sarak, Bradley ; Biria, Mazda ; Pillarisetti, Jayasree ; Bhat, Pradeep ; Di Biase, Luigi ; Constantini, Otto ; Quan, Kara ; Natale, Andrea. / Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy : A multicentre experience. In: Heart. 2010 ; Vol. 96, No. 7. pp. 510-515.
@article{f8887fede23244f7bb81975698788b9f,
title = "Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy: A multicentre experience",
abstract = "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{\%}), β 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.",
author = "Atul Verma and Zaev Wulffhart and Dhanunjaya Lakkireddy and Yaariv Khaykin and Alexander Kaplan and Bradley Sarak and Mazda Biria and Jayasree Pillarisetti and Pradeep Bhat and {Di Biase}, Luigi and Otto Constantini and Kara Quan and Andrea Natale",
year = "2010",
month = "4",
doi = "10.1136/hrt.2009.178061",
language = "English (US)",
volume = "96",
pages = "510--515",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",
number = "7",

}

TY - JOUR

T1 - Incidence of left ventricular function improvement after primary prevention ICD implantation for non-ischaemic dilated cardiomyopathy

T2 - A multicentre experience

AU - Verma, Atul

AU - Wulffhart, Zaev

AU - Lakkireddy, Dhanunjaya

AU - Khaykin, Yaariv

AU - Kaplan, Alexander

AU - Sarak, Bradley

AU - Biria, Mazda

AU - Pillarisetti, Jayasree

AU - Bhat, Pradeep

AU - Di Biase, Luigi

AU - Constantini, Otto

AU - Quan, Kara

AU - Natale, Andrea

PY - 2010/4

Y1 - 2010/4

N2 - 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%), β 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.

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%), β 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.

UR - http://www.scopus.com/inward/record.url?scp=77950612144&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950612144&partnerID=8YFLogxK

U2 - 10.1136/hrt.2009.178061

DO - 10.1136/hrt.2009.178061

M3 - Article

C2 - 19884110

AN - SCOPUS:77950612144

VL - 96

SP - 510

EP - 515

JO - Heart

JF - Heart

SN - 1355-6037

IS - 7

ER -