title: How can optimization of medical treatment avoid unnecessary implantable cardioverter-defibrillator implantations in patients with idiopathic dilated cardiomyopathy presenting with "SCD-HeFT criteria?".
abstract: To assess the proportion and long-term outcomes of patients with idiopathic dilated cardiomyopathy and potential indications for implantable cardioverter-defibrillator before and after optimization of medical treatment, 503 consecutive patients with idiopathic dilated cardiomyopathy were evaluated from 1988 to 2006. A total of 245 patients (49%) satisfied the "Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) criteria," defined as a left ventricular ejection fraction of ≤0.35 and New York Heart Association (NYHA) class II-III on registration. Among these, 162 (group A) were re-evaluated 5.4 ± 2 months later with concurrent β-blockers and angiotensin-converting enzyme inhibitor use. Of the 162 patients, 50 (31%) still had "SCD-HeFT criteria" (group A1), 109 (67%) had an improved left ventricular ejection fraction and/or New York Heart Association class (group A2), and 3 (2%) were in NYHA class IV. Of the 227 patients without baseline "SCD-HeFT criteria" (left ventricular ejection fraction >0.35 or NYHA class I), 125 were evaluated after 5.5 ± 2 months. Of these 227 patients, 13 (10%) developed "SCD-HeFT criteria" (group B1), 111 (89%) remained without "SCD-HeFT criteria" (group B2), and 1 (1%) had worsened to NYHA class IV. The 10-year mortality/heart transplantation and sudden death/sustained ventricular arrhythmia rate was 57% and 37% in group A1, 23% and 20% in group A2 (p <0.001 for mortality/heart transplantation and p = 0.014 for sudden death/sustained ventricular arrhythmia vs group A1), 45% and 41% in group B1 (p = NS vs group A1), 16% and 14% in group B2 (p = NS vs group A2), respectively. In conclusion, two thirds of patients with idiopathic dilated cardiomyopathy and "SCD-HeFT criteria" at presentation did not maintain implantable cardioverter-defibrillator indications 3 to 9 months later with optimal medical therapy. Their long-term outcome was excellent, similar to that observed for patients who had never met the "SCD-HeFT criteria."
authors.affiliation: Cardiovascular Department, Ospedali Riuniti and University of Trieste, Italy. massimo.zecchin@alice.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Zecchin
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.forename: Alberto
authors.initials: A
authors.lastname: Pivetta
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.forename: Cristina
authors.initials: C
authors.lastname: Lutman
authors.forename: Dario
authors.initials: D
authors.lastname: Gregori
authors.forename: Laura Vitali
authors.initials: LV
authors.lastname: Serdoz
authors.forename: Stefano
authors.initials: S
authors.lastname: Bardari
authors.forename: Silvia
authors.initials: S
authors.lastname: Magnani
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004305:Dose-Response Relationship, Drug; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors