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Incidence of Left Ventricular Function Improvement After Primary Prevention ICD Implantation for Non-Ischemic Dilated Cardiomyopathy: A Multicenter Experience
  1. Atul Verma1,*,
  2. Zaev Wulffhart1,
  3. Dhanunjaya Lakkireddy2,
  4. Yaariv Khaykin1,
  5. Alexander Kaplan1,
  6. Bradley Sarak1,
  7. Mazda Biria2,
  8. Jayasree Pillarisetti2,
  9. Pradeep Bhat3,
  10. Luigi DiBiase4,
  11. Otto Constantini3,
  12. Kara Quan3,
  13. Andrea Natale4
  1. 1 Southlake Regional Health Centre, Canada;
  2. 2 University of Kansas Medical Center, Canada;
  3. 3 MetroHealth Campus, Case Western Reserve University, United States;
  4. 4 St. David’s Medical Center, Canada
  1. Correspondence to: Atul Verma, Cardiology, Southlake Regional Health Centre, 105-712 Davis Drive, Newmarket, L3Y8C3, Canada; atul.verma{at}utoronto.ca

Abstract

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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