| How can optimization of medical treatment avoid unnecessary implantable cardioverter-defibrillator implantations in patients with idiopathic dilated cardiomyopathy presenting with "SCD-HeFT criteria?". | |
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MedLine Citation:
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PMID: 22176998 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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." |
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Authors:
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Massimo Zecchin; Marco Merlo; Alberto Pivetta; Giulia Barbati; Cristina Lutman; Dario Gregori; Laura Vitali Serdoz; Stefano Bardari; Silvia Magnani; Andrea Di Lenarda; Alessandro Proclemer; Gianfranco Sinagra |
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Publication Detail:
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Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial Date: 2011-12-15 |
Journal Detail:
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Title: The American journal of cardiology Volume: 109 ISSN: 1879-1913 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-02-27 Completed Date: 2012-04-24 Revised Date: 2012-08-13 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 729-35 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 Elsevier Inc. All rights reserved. |
Affiliation:
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Cardiovascular Department, Ospedali Riuniti and University of Trieste, Italy. massimo.zecchin@alice.it |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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administration & dosage,
therapeutic use* Adult Angiotensin-Converting Enzyme Inhibitors / administration & dosage, therapeutic use* Cardiomyopathy, Dilated / diagnosis, mortality, therapy* Defibrillators, Implantable / utilization* Dose-Response Relationship, Drug Electrocardiography, Ambulatory Female Follow-Up Studies Humans Italy / epidemiology Male Retrospective Studies Risk Factors Survival Rate / trends Time Factors Treatment Outcome Unnecessary Procedures / statistics & numerical data* |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors |
| Comments/Corrections | |
Comment In:
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Am J Cardiol. 2012 Jul 1;110(1):161-2
[PMID:
22704297
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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