Abstract
Patients With Recently Diagnosed Nonischemic Cardiomyopathy Benefit From Implantable Cardioverter-Defibrillators
Alan Kadish, Andi Schaechter, Haris Subacius, Emil Thattassery, William Sanders, Kelley P. Anderson, Alan Dyer, Jeffrey Goldberger, Joseph Levine
The Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial randomized 458 patients with nonischemic dilated cardiomyopathy to receive standard therapy with or without an implantable cardioverter-defibrillator (ICD). Patients were divided into recently and remotely diagnosed groups based on the time from diagnosis of cardiomyopathy to randomization. Patients with recently diagnosed cardiomyopathy who received an ICD had better survival than those treated with standard therapy at both cut points. However, there were no significant interactions between ICD effect and the recent versus remote diagnosis groups (p = 0.17 and p = 0.25). There is not a significant difference in ICD benefit between recently and remotely diagnosed patients.
This study sought to determine whether the time from diagnosis to randomization was related to outcome in a clinical trial of implantable cardioverter-defibrillator (ICD) insertion in nonischemic cardiomyopathy.
Whether the duration of nonischemic cardiomyopathy is related to arrhythmic risk and the possible benefit of ICD insertion is unknown.
The Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial randomized 458 patients with nonischemic dilated cardiomyopathy and a left ventricular ejection fraction <36% to receive standard medical therapy with or without an ICD. Patients were randomized regardless of the duration of known cardiomyopathy as long as a reversible cause of left ventricular dysfunction was not present. Patients were divided into recently and remotely diagnosed nonischemic cardiomyopathy groups based on the time from diagnosis of cardiomyopathy to randomization. To categorize patients, cut points of three and nine months were used.
Patients with recently diagnosed cardiomyopathy who received an ICD had better survival than those treated with standard therapy at both cut points. This difference in survival was significant at three months (p < 0.05) and was borderline significant at nine months (p = 0.058). Patients with remotely diagnosed cardiomyopathy did not have a significant survival benefit with ICD insertion, but there were no significant differences between ICD benefit in the recent and remote diagnosis groups (p = 0.17 and 0.25).
Patients who have a recent cardiomyopathy diagnosis do not have any less ICD benefit than those with a remote diagnosis. Thus, ICD therapy should be considered in such patients as soon as they are identified as long as a reversible cause of left ventricular dysfunction is excluded.
