Prognose von Patienten mit dilatativer Kardiomyopathie und prophylaktischer ICD-Therapie

This study investigated a group of patients with dilated cardiomyopathy (DCM) and prophylactic ICD-implantation. We analyzed predictors of total mortality and necessity for heart transplantation in 133 patients with DCM and primary ICD-implantation. All patients underwent echocardiography at the time of ICD-implantation. Echocardiography was repeated during mean follow-up of 11 months after implantation. Thirty-two percent of all study patients improved their ejection fraction by more than 5% and reduced left ventricular enddiastolic diameter (LVEDD) more than 5 mm by the time of a repeated echocardiographic assessment. The improvement of LV-function occurred significantly more often in patients with a symptom duration less than 1 year compared to patients with a symptom duration above 1 year (43% vs 22%, p<0.05). The improvement of LV-function at follow-up echocardiography predicted a better long-term survival rate without heart transplantation. Moreover, treatment with ACE inhibitors, ß-blockers, aldosteron antagonists and successful cardiac resynchronisation was associated with a better transplant-free survival, whereas spontaneous ICD shocks were associated with a higher mortality. Our study has the following clinical implications: 1) LV-function should be evaluated repeatedly by echocardiography during the course of 12 months for all patients with recently diagnosed DCM because the results of repeated echocardiography are predictive for long-term outcome. 2) All patients with DCM and a short symptom duration should be receive optimal medical therapy for at least 3 to 6 months prior to ICD implantation because LV ejection fractionn may improve in many patients over this time period and, therefore, these patients may not need an implant of cardioverter-defibrillator. 3) In patients with DCM and left branch block with QRS durations of more than 150 ms who need in accordance with SCD-HeFT criteria an ICD implantation, a CRT-ICD should be preferred. 4) Patients with DCM and spontaneous shocks for ventricular tachycardia or ventricular fibrillation have an increased mortality and should be followed more intensly with optimization of heart failure therapy including ACE inhibitors, ß-blockers, and aldosteron antagonists.