Circulation, Vol 83, 52-60, Copyright © 1991 by American Heart Association
RE Goldstein, SJ Boccuzzi, D Cruess and S Nattel
The Multicenter Diltiazem Postinfarction Trial (MDPIT) reported no
consistent diltiazem effect on new or worsened congestive heart failure
(CHF) during 12-52 months' follow-up after acute myocardial infarction.
This was puzzling in light of the observation that patients with findings
suggesting left ventricular dysfunction (LVD) at baseline on diltiazem had
more cardiac events (cardiac mortality or recurrent nonfatal infarction)
than such patients on placebo. We hypothesized that diltiazem increased the
frequency of late CHF as well as of cardiac events, but only in patients
predisposed by LVD. Using the same characterizing variables as the primary
MDPIT analysis, we found that patients with pulmonary congestion,
anterolateral Q wave infarction, or reduced ejection fraction (EF) at
baseline were more likely to have CHF during follow-up than those without
these markers of LVD. CHF was particularly frequent in the patients with
LVD who were randomized to diltiazem. Among those with a baseline EF of
less than 0.40, late CHF appeared in 12% (39/326) receiving placebo and 21%
(61/297) receiving diltiazem (p = 0.004). Life table analysis in patients
with an EF of less than 0.40 confirmed more frequent late CHF in those
taking diltiazem (p = 0.0017). In addition, the diltiazem-associated rise
in the frequency of late CHF was progressively greater with increasingly
severe decrements in baseline EF. This diltiazem effect was absent in
patients with pulmonary congestion at baseline but an EF of 0.40 or more,
suggesting a unique association between diltiazem-related late CHF and
systolic LVD.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md. 20814-4799.
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