Verma A, Wulffhart Z, Lakkireddy D, Khaykin Y, Kaplan A, Sarak B, Biria M, Pillarisetti J, Bhat P, Dibiase L, Constantini O, Quan K, Natale A
Incidence of Left Ventricular Function Improvement After Primary Prevention ICD Implantation for Non-Ischemic Dilated Cardiomyopathy: A Multicenter Experience. [JOURNAL ARTICLE]
Heart 2009 Nov 1.
OBJECTIVE: We sought to assess the incidence of LV function improvement in patients receiving primary prevention ICDs for NIDCM.
METHODS: All NICM patients receiving primary prevention ICDs (non-CRT) from 2005-present at our institutions were studied. Patients had NIDCM confirmed by a lack of significant stenoses on coronary angiography, a lack of valvular abnormalities on echo, and LV dysfunction with EF<35%. Patients had to have a diagnosis of NIDCM for >9 months and be on optimal medical therapy for >3 months prior to implant. All patients had >NYHA II symptoms. Baseline and follow-up EF was documented by quantitative echo and/or MUGA scan.
RESULTS: 332 patients were identified via a database search. Patients were 67+/-11 years, 75% 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 therapy pre-implant was 8+/-5 months. Therapy 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 post-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 predictors were identified for patients with improved EF.
CONCLUSIONS: A substantial number of patients (12%) with NIDCM experience improvement in LV function to above levels recommended for ICD implant. A shorter time from diagnosis to implant may predict post-implant improvement.
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