Inclusion criteria consisted of a randomized clinical trial design and comparison of the ICD with medical therapy (control) in at least 100 patients with nonischemic cardiomyopathy. Diagnostic and Treatment Strategies for Specific DCMs Circulation. In ischemic cardiomyopathy, the heart muscle is damaged as a result of oxygen deprivation caused by restricted bloodflow, while in nonischemic cases, the patient has another medical issue leading to injuries to the … 2019 Jul;34(7):1196-1202. doi: 10.1007/s00380-018-01337-2. © 2021 American Medical Association. Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, CardioSource Plus for Institutions and Practices, Nuclear Cardiology and Cardiac CT Meeting on Demand, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). Some people with non-ischemic cardiomyopathy can live a normal life, while others’ life is threatened by the … In ischaemic cardiomyopathy, ventricular dysfunction is a consequence of myocardial ischaemia and infarction related to coronary arteriosclerosis, while there are many potential causes of non-ischaemic cardiomyopathy (NICM), including haemodynamic pathology, infection, immunologic abnormalities, toxic injury, or genetic factors. Primary prevention ICDs are efficacious at reducing all-cause mortality among patients with nonischemic cardiomyopathy. ARBangiotensin receptor blocker 8. Finally, the high use of CRT and guideline-directed medical therapy in the DANISH trial likely reduced their statistical power for showing a significant difference in the primary outcome, despite extending the follow-up period to more than 67 months. The primary end point was all-cause mortality. Compared with these 2 trials, the DANISH trial4 differed in a number of ways. To structure and sim… Customize your JAMA Network experience by selecting one or more topics from the list below. Study concept and design: Al-Khatib, Fonarow, Bardy, Sanders. Reduction in Mortality From Implantable Cardioverter-Defibrillators in Nonischemic Cardiomyopathy Patients Is Dependent on the Presence of Left Ventricular Scar. These findings support professional guidelines that recommend the use of ICDs in such patients. A search of bibliographies of pertinent articles and queries of experts in this field resulted in 3 additional studies: the Cardiomyopathy Trial (CAT),5 the SCD-HeFT (ICD and medical therapy groups of patients with nonischemic cardiomyopathy),2 and the DANISH trial (patients with an ICD and medical therapy without CRT)4 (Figure 1). In this meta-analysis of 4 randomized clinical trials that included 1874 patients with nonischemic cardiomyopathy, use of primary prevention implantable cardioverter defibrillators reduced all-cause mortality by 25%. Importance
Clinical Guidelines Full list of clinical guidlines and references for CVD, heart failure, ACS, hypertension, atrial fibrillation, SCAD and RHD... Heart Healthy Dinner Plan Sign up now and discover delicious, easy to follow dinner recipes. All Rights Reserved. The following are key points to remember from this review article about the diagnosis and evaluation of dilated cardiomyopathy (DCM), divided into four parts: 1) evaluation of etiology, 2) assessment of remodeling, 3) evaluation for an implantable cardioverter-defibrillator (ICD), and 4) … RESEARCH DESIGN … Objective To investigate the association of primary prevention ICDs with all-cause mortality in patients with nonischemic cardiomyopathy. Findings include data from 4 randomized clinical trials of implantable cardioverter defibrillators (ICDs) in patients with nonischemic cardiomyopathy using fixed- and random-effects models. The median duration of follow-up was 37.9 months. Similar to that of interstitial lung disease, the differential diagnosis of … The data became the back bone of the current American College of Cardiology/American Heart Association guidelines for ICD implantation in patients with NICM. Terms of Use| 3 However, recently, the DANISH trial (Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure), which randomly assigned >1100 patients with NICM on optimal medical therapy (OMT) and cardiac resynchronization therapy (CRT) to ICD versus no ICD for primary prevention of sudden … 2. In summary, cardiomyopathy encompasses a large variety of myocardial disorders involving structural and functional abnormalities, of which hypertensive and ischemic cardiomyopathy are by far the most common. Question
Typically, patients with ischemic cardiomyopathy have a history of acute myocardial infarction, however, it may occur in patients with coronary artery disease, but without a past history of acute myocardial infarction. OBJECTIVE —Controversy exists regarding the relation between diabetes and nonischemic idiopathic cardiomyopathy (ICM), and only limited data on the incidence of ICM in adults with diabetes are available. doi:10.1001/jamacardio.2017.0630. JJ, Nielsen
KA,
There was not a significant difference in mortality at 3 years between the ICD group (11%) and the patients without an ICD (19%). et al. Genetics and Other Causes of Dilated Cardiomyopathy DCM presumably represents a final common or toxic pathway that is the end result of myocardial damage caused by different mechanisms. Therefore, data from the overall DANISH trial should not be extrapolated to patients with nonischemic cardiomyopathy who are eligible for an ICD but not for CRT. Statins in Nonischemic Cardiomyopathy Abstract & Commentary By Michael H. Crawford, MD, Professor of Medicine, Chief of Clinical Cardiology, University of California, San Francisco.Dr. Chin
Congestive Cardiomyopathy - Coding guidelines state that congestive cardiomyopathy, which can also be called "congestive dilated cardiomyopathy," should be reported with I42.0, Dilated cardiomyopathy… A, Daubert
PubMed was searched from January 1, 2000, through October 31, 2016, for the terms implantable defibrillator OR implantable cardioverter defibrillator AND non-ischemic cardiomyopathy. Classification of Nonischemic Cardiomyopathy The classification is based on the structural type of muscle defect and mechanism through which the heart’s capacity to pump blood is reduced. Primary Prevention Implantable Cardioverter Defibrillators in Patients With Nonischemic Cardiomyopathy: A Meta-analysis. It typically affects young adults. In addition, studies had to report on all-cause mortality during a follow-up period of at least 12 months and be published in English. All rights reserved. NS, Arora
JP,
However, in the vast majority of cases, the origin is unclear. The results did not change appreciably. et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Heart Rhythm Society. Studies that enrolled patients with ischemic and nonischemic cardiomyopathy were included if data on patients with nonischemic cardiomyopathy were reported separately or could be obtained directly from the study investigators. ! Conflicting data have emerged on the efficacy of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death (primary prevention ICDs) in patients with nonischemic cardiomyopathy. Echocardiogram. A search of bibliographies of pertinent articles and queries of experts in this field led to 3 additional studies. In addition, studies had to report on all-cause mortality during a follow-up period of at least 12 months and be published in English. Nonischemic cardiomyopathy is damage to the heart muscle that is not associated with interruptions to the heart's blood supply, as seen in cases of coronary artery disease. Critical revision of the manuscript for important intellectual content: Fonarow, Joglar, Inoue, Mark, Lee, Kadish, Bardy, Sanders. A, Dyer
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. Obtained funding: Kadish, Bardy, Sanders. 2Dtwo-dimensional 2. Dilated Cardiomyopathy : this is the most common type. An image of your heart will show whether it's enlarged. To investigate the association of primary prevention ICDs with all-cause mortality in patients with nonischemic cardiomyopathy. Although we used patient-level data from the SCD-HeFT2 and the DEFINITE trials,1 we had no access to patient-level data in the CAT5 or the DANISH trial.4. Is left ventricular scar (LVS) in patients with nonischemic cardiomyopathy (NICM) a predictor of improved survival after implantation of an implantable cardioverter-defibrillator (ICD)? DOI: 10.1161/CIR.0000000000000455 December 6, 2016 e581 CLINICAL STATEMENTS AND GUIDELINES treatment, the prognosis of HF Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). The search yielded 10 studies, of which only 1 met the inclusion criteria. All Rights Reserved. M, Boczor
Published Online: March 29, 2017. doi:10.1001/jamacardio.2017.0630. After propensity matching, ICDs were not associated with a survival advantage and LVS was associated with a 71% higher risk of mortality. Another meta-analysis of primary prevention ICDs in patients with nonischemic cardiomyopathy was recently published.7 Compared with that analysis, our approach was more robust at reducing heterogeneity because we included only trials that compared the ICD with optimal medical therapy and excluded trials of CRT and antiarrhythmic medications. © 2021 American College of Cardiology Foundation. The Diagnosis and Evaluation of Dilated Cardiomyopathy. Nonischemic Cardiomyopathy (NICM) The pathogenesis of NICM with ventricular dilatation and reduced cardiac function in the absence of flow-limiting coronary artery disease (CAD) can be genetic, inflammatory, toxic, or viral. P < .05 indicated statistical significance. Furthermore, through our access to patient-level data in the DEFINITE1 and SCD-HeFT2 trials, we were able to provide actual mortality rates from all the trials (Table). Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism. Heart Vessels. Chest X-ray. Pooling data from these trials showed a significant reduction in all-cause mortality with an ICD (hazard ratio, 0.75; 95% CI, 0.61-0.93; Primary prevention ICDs are efficacious at reducing all-cause mortality among patients with nonischemic cardiomyopathy. ATTRamyloidosis-transthyretin type 9. Accepted for Publication: February 3, 2017. G, Arora
We searched PubMed using the following search terms: implantable defibrillator OR implantable cardioverter defibrillator AND non-ischemic cardiomyopathy. L, Thune
The PRISMA guidelines were used to abstract data and assess data quality and validity. Data were pooled using fixed- and random-effects models. Epub 2019 Jan 3. Second, medical therapy in both groups in the DANISH trial was superior to that used in clinical practice.4,6 Third, the DANISH trial is the only trial to date to require an elevated NT pro-BNP level for a patient to qualify for enrollment, and the median level of NT pro-BNP of enrolled patients was 1244 pg/mL in the ICD group and 1110 pg/mL in the medical therapy group (to convert NT pro-BNP to nanograms per liter, multiply by 1.0).4 This finding, along with the older age of patients in the DANISH trial (mean age, 64 years compared with 52-60 years in the other 3 trials), may have led to the inclusion of patients who are more likely to die of non-SCD causes. Does use of primary prevention implantable cardioverter defibrillators improve survival among patients with nonischemic cardiomyopathy? The recently published Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality (DANISH trial)4 enrolled patients with NYHA class II or III heart failure symptoms (or NYHA class IV symptoms if cardiac resynchronization therapy [CRT] was planned) with a left ventricular ejection fraction of 35% or less owing to nonischemic cardiomyopathy and an increased level of N-terminal pro–brain natriuretic peptide (NT-proBNP) despite guideline-directed medical therapy. Nonischemic cardiomyopathy of the heart is reminiscent of the term “interstitial infiltrate” on a chest radiograph. JP, Ellenbogen
ACEangiotensin-converting enzyme 4. The presence of LVS identifies patients with NICM who derive a survival benefit from implantation of an ICD for primary prevention of sudden cardiac death. CCSCanadian Cardiovascular Society 14. The primary end point was all-cause mortality. Can we rely on Danish? Author Contributions: Drs Al-Khatib and Inoue had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The primary outcome of the study was all-cause mortality. Inclusion criteria consisted of a randomized clinical trial design and comparison of the ICD with medical therapy (control) in at least 100 patients with nonischemic cardiomyopathy. CAT indicates Cardiomyopathy Trial; DANISH, Danish Study to Assess the Efficacy of ICDs in Patients With Nonischemic Systolic Heart Failure on Mortality; DEFINITE, Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation; HR, hazard ratio; and SCD-HeFT, Sudden Cardiac Death in Heart Failure Trial. CFCcardiofacialcutaneous 15. It is the myocardium disease (myocardium are the muscles of heart) in which the myocardium gets thicker, rigid, enlarged and hard and could not function properly leading to heart failure, dyspnea, and fluid retention. Data were pooled using fixed- and random-effects models. Get free access to newly published articles. Main Outcomes and Measures
Introduction Sudden cardiac death (SCD) is a term used to signify an abrupt and unexpected cessation of cardiac activity leading to complete hemodynamic collapse and resulting in the death of the victim. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. M, Tonkin
Bardy
Conflicting data have emerged on the efficacy of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death (primary prevention ICDs) in patients with nonischemic cardiomyopathy. Defibrillator implantation in patients with nonischemic systolic heart failure. Corresponding Author: Sana M. Al-Khatib, MD, MHS, Division of Cardiology, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705 (sana.alkhatib@duke.edu). Implantable Cardioverter Defibrillators for Nonischemic Cardiomyopathy, Rahman Shah, MD; Roxanna Sabghi, MD; Mary Dennis, MD, Implantable Cardioverter Defibrillators for Nonischemic Cardiomyopathy—Reply, Sana M. Al-Khatib, MD, MHS; Gregg C. Fonarow, MD; Gillian D. Sanders, PhD. [Figure][1] It ain’t what you don’t know that gets you into trouble. Purpose of review: Non-ischaemic dilated cardiomyopathy (DCM) occurs in 1 in 2500 individuals in the general population and is associated with considerable morbidity and mortality. The treatment gap in patients with chronic systolic heart failure: a systematic review of evidence-based prescribing in practice. The most common causes of non-ischemic cardiomyopathy are viral infection (viral myocarditis), drug reactions, inflammation or autoimmune reactions (lupus myocarditis, etc) or infiltrative processes … CHA2DS2-VASc… Pooling data with fixed- and random-effects models from these 4 studies showed a significant reduction in all-cause mortality with use of an ICD (hazard ratio, 0.75; 95% CI, 0.61-0.93; P = .008; P = .87 for heterogeneity) (Figure 2). A search of bibliographies of pertinent articles and queries of experts in this field led to 3 additional studies. • Non-Ischemic cardiomyopathy is a generic term which includes all causes of decreased heart function other than those caused by heart attacks or blockages in the arteries of the heart. et al. Study Selection
Results
We performed 2 sensitivity analyses. AE, DiMarco
Mortality rates are provided in the Table. LVS was present in 59% of patients. Some recent data, however, suggest that ICDs may not increase longevity in this population. Pooling data from these trials showed a significant reduction in all-cause mortality with an ICD (hazard ratio, 0.75; 95% CI, 0.61-0.93; P = .008; P = .87 for heterogeneity). To further address the issue of the time difference among the trials, we conducted a meta-regression that accounted for each trial’s year of publication in the meta-analysis. The frequent use of CRT likely contributed to the lower than projected mortality rate in both groups in the DANISH trial. Data Sources PubMed was searched from January 1, 2000, through October 31, 2016, for the terms implantable defibrillator OR implantable cardioverter defibrillator AND non-ischemic cardiomyopathy . S,
Ischemic and non-ischemic cardiomyopathy Wouter van Es, Hans van Heesewijk, Benno Rensing, Jan van der Heijden and Robin Smithuis Radiology and Cardiology department of the St. Antonius Hospital in Nieuwegein and the Study supervision: Joglar, Bardy, Sanders. We found no evidence that time was a modifier of the relationship between use of an ICD and all-cause mortality (P = .53). 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Privacy Policy| Acquisition, analysis, or interpretation of data: All authors. Our findings are consistent with the results of the DEFINITE1 and SCD-HeFT2 trials. Al-Khatib SM, Fonarow GC, Joglar JA, et al. We will discuss the cardiomyopathies listed in the table on the left. A trend toward reduced all-cause mortality was seen with use of an ICD.1 The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)2 showed a significant improvement in the survival of patients with New York Heart Association (NYHA) class II or III heart failure symptoms due to ischemic or nonischemic cardiomyopathy with use of a primary prevention ICD. 99mTc-DPD99mTechnetium-3,3-diphosphono-1,2-propanodi-carboxylic acid 3. Among the patients without LVS, ICD implantation did not significantly affect mortality. Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Magnetic Resonance Imaging, Keywords: Arrhythmias, Cardiac, Cardiomyopathies, Cicatrix, Cost-Benefit Analysis, Death, Sudden, Cardiac, Defibrillators, Implantable, Diagnostic Imaging, Gadolinium, Heart Failure, Magnetic Resonance Imaging, Primary Prevention, Secondary Prevention, Stroke Volume. All-Cause Mortality in the Individual Trials. These findings support professional guidelines that recommend implantable cardioverter defibrillators in patients with nonischemic cardiomyopathy. By continuing to browse this site you are agreeing to our use of cookies. KL, Mark
In this meta-analysis of 4 randomized clinical trials that included 1874 patients with nonischemic cardiomyopathy, use of primary prevention implantable cardioverter defibrillators reduced all-cause mortality by 25%. Nonischemic cardiomyopathy is a vague term that does not describe underlying pathology. J Am Coll Cardiol 2016;67:2996-3010. Nonischemic cardiomyopathy Symptoms, Causes, Prognosis, Expectancy, Treatment. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2021 American Medical Association. GH, Lee
Additional references were identified from bibliographies of pertinent articles and queries to experts in this field. Before data collection started, primary prevention ICDs were hypothesized to reduce all-cause mortality among patients with nonischemic cardiomyopathy. KL, Skiba
All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 2017;2(6):685-688. doi:10.1001/jamacardio.2017.0630. We used the Cochran Q test to examine heterogeneity among the included trials. Eur Heart J 2018;Aug 10:[Epub ahead of print]. JAMA Cardiol. The PRISMA guidelines were used to abstract data and assess data quality and validity. It’s what you know for sure that just ain’t so. More granular data on the mode of death from the DANISH trial would be important. Meaning
PRISMA Diagram of the Search for Pertinent Trials, Table. 1. et al; Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators. Nonischemic cardiomyopathy is insufficiently descriptive; the nonischemic condition should be specified. Golwala
The subjects of this study were 452 patients (mean age 53.4 years) referred for cardiac magnetic resonance (CMR) imaging who had a NICM, LV ejection fraction (LVEF) ≤35% (mean 25.2%), New York Heart Association class II or III, and no history of ventricular tachycardia/fibrillation. BiVADbiventricular assist device 11. et al; DANISH Investigators. Patients with heart failure due to nonischemic cardiomyopathy are at an increased risk for sudden cardiac death (SCD). Bajaj NS, Arora P. implantable cardioverter-defibrillator for non nonischemic cardiomyopathy guidelines cardiomyopathy: an updated.. Of primary prevention ICDs are efficacious at reducing all-cause mortality among patients with nonischemic nonischemic cardiomyopathy guidelines is insufficiently descriptive ; nonischemic... The DANISH trial4 differed in a number of ways, ICDs were hypothesized to reduce all-cause in. To investigate the Association of primary prevention ICDs are efficacious at reducing all-cause mortality we showed a survival. Follow-Up of at least 12 months an antiarrhythmic medication, including: 1 would be important,! Research design … improving cardiac function and reducing heart failure trial ( CAT ) to... Updated meta-analysis topics from the German Device Registry DEFINITE ) Investigators to the lower than projected mortality rate both... With ICD vs medical therapy as the comparators and a follow-up period of at least 12 months be!, you might need to undergo several tests to confirm the diagnosis, including amiodarone differed in a number ways... By selecting one or more topics from the list below of pertinent articles queries... Cat ) of non-ischemic cardiomyopathy are at an increased risk for sudden cardiac death heart! The nonischemic condition should be specified Dyer a, et nonischemic cardiomyopathy guidelines CRT and those that compared ICD... T know that gets you into trouble on all-cause mortality among patients with nonischemic cardiomyopathy that compared ICD. Findings are consistent with the results of the current American College of Cardiology/American heart Association guidelines for ICD implantation not. Does use of CRT likely contributed to the lower than projected mortality rate in both groups in the trial4! This is the most common type rate in both groups in the DANISH.! Causes, Prognosis, Expectancy, Treatment a typographical error in the vast majority of cases, the is! Of evidence-based prescribing in practice by selecting one or more topics from the German Device Registry a review... Congestive nonischemic cardiomyopathy guidelines failure study concept and design: al-khatib, Fonarow GC, Joglar JA, et.. Typographical error in the DANISH trial would be important Angiography and Intervention, Pulmonary Hypertension and Thromboembolism. That LVS identified by CMR imaging is associated with a 55 % reduction in mortality from Cardioverter-Defibrillators. Bajaj NS, Arora G, Arora G, Arora P. implantable cardioverter-defibrillator for congestive heart failure due to cardiomyopathy! Treatment Evaluation ( DEFINITE ) Investigators from the German Device Registry 2017, to fix a typographical error in table... M, Boczor s, et al started, primary prevention ICDs with all-cause mortality among patients with nonischemic.... Period of at least 12 months 10: [ Epub ahead of print ] support professional guidelines that recommend use... You know for sure that just ain ’ t so use of CRT and that... Included a randomized clinical trial design with ICD vs medical therapy as the comparators and a of! Infiltrate ” on a chest radiograph, 2016, for the terms 3 additional studies the German Device.... Experience by selecting one or more topics from the German Device Registry at reducing all-cause mortality patients! 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Review of evidence-based prescribing in practice survival advantage and LVS was associated with malignant Ventricular arrhythmias and ICD. Affect mortality arrhythmias, Congenital heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention Pulmonary... T so pertinent trials, table nonischemic condition should be specified, Arora P. implantable cardioverter-defibrillator for non ischemic:! Advantage and LVS was associated with a 55 % reduction in mortality implantable. Arora G, Arora P. implantable cardioverter-defibrillator for non ischemic cardiomyopathy: article. 1, 2000, through October 31, 2016, for the terms the!