Cited by 525Heart Failure Treatment and ManagementAcute Myocardial Infarction ResearchCardiac Fibrosis and Remodeling

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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

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Goldstein, R E, Boccuzzi, S J, Cruess, D, Nattel, S·1991·Circulation

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Abstract

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)

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Authors: Goldstein, R. E., Boccuzzi, S. J., Cruess, D., & Nattel, S.
Affiliations: Uniformed Services University of the Health Sciences (US)
ORCID: Goldstein, R E
Nattel, S
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1991-01
Volume: 83
Issue: 1
Pages: 52-60
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/01.cir.83.1.52
OpenAlex: W2090674352
Cited by: 521
References: 0
Citations by year: 2026: 5 · 2025: 13 · 2024: 14 · 2023: 16 · 2022: 16 · 2021: 7 · 2020: 24 · 2019: 13 · 2018: 15 · 2017: 17 · 2016: 15 · 2015: 17 · 2014: 4 · 2013: 16 · 2012: 11
FWCI: 17.90
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Funders: Henry M. Jackson Foundation
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
Keywords: diltiazem, congestive heart failure, myocardial infarction, left ventricular dysfunction, ejection fraction, calcium channel blockers, pulmonary congestion, adverse drug reactions
MeSH terms: Diltiazem, Double-Blind Method, Follow-Up Studies, Heart Failure, Humans, Myocardial Infarction, Stroke Volume, Life Tables, Ventricular Function, Left

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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

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