Abstract 1882: Changing Proportion of Patients with Dilated Cardiomyopathy with SCDHeFT and CARE-HF/Companion Characteristics During Follow-up on Optimal Medical Treatment
Background. Recently published trials on ICD and resynchronization therapy (RCT) defined the characteristics of pts with idiopathic dilated cardiomyopathy (DC) who should be treated with these devices. However, trials involving pts with an early diagnosis failed to show a benefit from ICD implantation, probably because of a relatively high rate of significant improvement on optimal medical therapy, with consequent risk reduction. Aim of the study. To evaluate how the proportion of pts candidates to ICD and RCT changes at diagnosis and during regular follow on optimal medical treatment.
Methods. Patients with DC enrolled in our Registry from 1978 to 2002 were evaluated at diagnosis and after 6, 12 and 24 months (mo) to analyse the number of candidates to ICD implantation according to SCDHeFT criteria (LVEF≤ 0.35, NYHA class II-III) and to RCT (with or without ICD) according to CARE-HF/Companion criteria (LVEF≤ 0.35, NYHA class III-IV, LBBB).
Results. Four hundred and five patients (age 43±14, LVEF 0.30±70.09, NYHA class 2±0.8) were evaluated at diagnosis and 319 survived and were followed for 2 years. During this period 82% were treated with β-blockers and 86% with ACE-inhibitors. After 6, 12 and 24 months, total (and sudden) death was respectively 7% (2%), 9% (3%) and 13% (3%). The proportion of patients who satisfied SCDHeFT criteria decreased from 53% (at diagnosis) to 23% (6mo), 22% (12 mo) and 21% (24 mo); the proportion of pts who satisfied CARE-HF/Companion criteria was 11% at diagnosis, but only 4%, 3% and 4% at 6, 12 and 24 mo.
Conclusions. The proportion of patients matching the criteria for ICD implantation and RCT according to most recent trials dropped significantly after 6 months on optimal medical treatment with a low rate of total and especially sudden mortality in the meanwhile. These data should be carefully considered in deciding the time of device implantation