Is implantable defibrillator therapy the therapy of choice for all patients with malignant ventricular tachyarrhythmias?

ventricular volume. Therefore, a cutpoint of 8% for an increase in EDVI was chosen. We agree with Dr Armstrong that the results of discriminant analysis should be applied with caution, as outlined in the discussion on page 762. Of particular importance are the baseline characteristics of the study population, which include age as well as other variables (Table 1).' Multivariate discriminant analysis in the present study was used to derive variables that allow to predict the development of left ventricular dilatation and dysfunction, which belong to the most powerful determinants of mortality after infarction. The finding of Pfeffer et al5 to which Dr Armstrong's last comment might refer to-that captopril significantly reduced the risk for reinfarction-is an important and extremely exciting finding. However, the respective mechanisms and the characteristics of the patients at risk should be known before angiotensin convering enzyme inhibitors may be recommended in general for the prevention of reinfarction. Nevertheless, the variables identified by multivariate analysis in our study (Table 4)1 allow identification of patients at high risk for progressive left ventricular dilatation and late deterioration of ventricular performance within 4 weeks after infarction who, at current understanding, may have the greatest benefit from therapy with angiotensin converting enzyme inhibitors. Peter Gaudron, MD Medizinische Universitatsklinik Wurzburg, Germany