Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dysfunction in patients with heart failure. SOLVD Investigators.

Konstam, Marvin A.; Rousseau, Michel F.; Kronenberg, Marvin W.; Udelson, James E.; Melin, Jacques; Stewart, Dawn; Dolan, Noreen; Edens, Tonya R.; Ahn, Sylvie A.; Kinan, Debra

doi:10.1161/01.cir.86.2.431

Cited by 496 publications

(223 citation statements)

References 35 publications

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“…19,20 Baseline dP/dt max values in the present study group were remarkably low despite the absence of bradycardia or systolic hypotension. Many previous studies of DCM in which patients with conduction delay were not targeted 8,[21][22][23] have reported consistent values for dP/dt max of Ϸ900 mm/s, 30% higher than in the present study but similar to values during pacing. Yet, the functional status, ejection fraction, etc, of the present patient group was indistinguishable from those in these previous studies.…”

Section: Discussionsupporting

confidence: 86%

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

et al. 2000

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Background-VDD pacing can enhance systolic function in patients with dilated cardiomyopathy and discoordinate contraction; however, identification of patients likely to benefit is unclear. We tested predictors of systolic responsiveness on the basis of global parameters as well as directly assessed mechanical dyssynchrony. Methods and Results-Twenty-two DCM patients with conduction delay were studied by cardiac catheterization with a dual-sensor micromanometer to measure LV and aortic pressures during sinus rhythm and LV free-wall pacing. Pacing enhanced isovolumetric (dP/dt max ) and ejection-phase (pulse pressure, PP) systolic function by 35Ϯ21% and 16.4Ϯ11%, respectively, and these changes correlated directly (rϭ0.7, Pϭ0.001). %⌬dP/dt max was weakly predicted by baseline QRS (rϭ0.6, PϽ0.02), more strongly by baseline dP/dt max (rϭ0.7, Pϭ0.001), and best by bidiscriminate analysis combining baseline dP/dt max Յ700 mm Hg/s and QRS Ն155 ms to predict %⌬dP/dt max Ն25% and %⌬PP Ն10% (PϽ0.0005, 2 ), with no false-positives. Benefit could not be predicted by %⌬QRS. To test whether basal mechanical dyssynchrony predicted responsiveness to LV pacing, circumferential strains were determined at Ϸ80 sites throughout the LV by tagged MRI in 8 DCM patients and 7 additional control subjects. Strain variance at time of maximal shortening indexed dyssynchrony, averaging 28.0Ϯ7.1% in normal subjects versus 201.4Ϯ84.3% in DCM patients (Pϭ0.001). Mechanical dyssynchrony also correlated directly with %⌬dP/dt max (rϭ0.85, Pϭ0.008). Conclusions-These results show that although mechanical dyssynchrony is a key predictor for pacing efficacy in DCM patients with conduction delay, combining information about QRS and basal dP/dt max provides an excellent tool to identify maximal responders.

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Section: Discussionsupporting

confidence: 86%

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

et al. 2000

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“…Left ventricular remodelling is affected by various kinds of neurohumoral and local factors such as the renin–angiotensin–aldosterone system, the adrenergic nervous system, increased oxidative stress, proinflammatory cytokines, and endothelin 13, 14, 15, 16, 17. However, the precise mechanisms that cause LV remodelling are still unclear.…”

Section: Discussionmentioning

confidence: 99%

Significance of myocardial tenascin‐C expression in left ventricular remodelling and long‐term outcome in patients with dilated cardiomyopathy

Yokokawa

Sugano

Nakayama

et al. 2016

European J of Heart Fail

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AimDilated cardiomyopathy (DCM) has a variety of causes, and no useful approach to predict left ventricular (LV) remodelling and long‐term outcome has yet been established. Myocardial tenascin‐C (TNC) is known to appear under pathological conditions, possibly to regulate cardiac remodelling. The aim of this study was to clarify the significance of myocardial TNC expression in LV remodelling and the long‐term outcome in DCM.Methods and resultsOne hundred and twenty‐three consecutive DCM patients who underwent endomyocardial biopsy for initial diagnosis were studied. Expression of TNC in biopsy sections was analysed immunohistochemically to quantify the ratio of the TNC‐positive area to the whole myocardial tissue area (TNC area). Clinical parameters associated with TNC area were investigated. The patients were divided into two groups based on receiver operating characteristic analysis of TNC area to predict death: high TNC group with TNC area ≥2.3% (22 patients) and low TNC group with TNC area <2.3% (101 patients). High TNC was associated with diabetes mellitus. Comparing echocardiographic findings between before and 9 months after endomyocardial biopsy, the low TNC group was associated with decreased LV end‐diastolic diameter and increased LV ejection fraction, whereas the high TNC group was not. Survival analysis revealed a worse outcome in the high TNC group than in the low TNC group (P < 0.001). Multivariable Cox regression analysis revealed that TNC area was independently associated with poor outcome (HR = 1.347, P = 0.032).ConclusionsIncreased myocardial TNC expression was associated with worse LV remodeling and long‐term outcome in DCM.

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“…[4][5][6][7][8][9] Konstam et al reported that ACEI and -blockers can slow or reverse LV dilation and remodeling in patients with heart failure and the main effects of ACEI on LV dilation are observed in the first few months of therapy. 10 However, even after the introduction of these medications, there are still some cases that are difficult to manage medically and for these biventricular pacemaker therapy or surgical intervention, such as heart transplantation or the Batista procedure, are indicated. Therefore, risk prediction in patients with NIDCM is crucial for selection of the best treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

Prolonged QRS Duration and Severity of Mitral Regurgitation are Unfavorable Prognostic Markers of Heart Failure in Patients With Nonischemic Dilated Cardiomyopathy

Amiya

Tanabe

Ikari

et al. 2006

Circ J

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eart failure may be defined as the inability of the heart to meet the demands of the tissues, resulting in symptoms of fatigue or dyspnea on exertion progressing to dyspnea at rest. Patients with nonischemic dilated cardiomyopathy (NIDCM) constitute the largest group of myopathic disorders that are responsible for systolic heart failure. In most multicenter, randomized heart-failure trials, approximately one-third of the enrolled patients have NIDCM. The term NIDCM refers to a spectrum of heterogeneous myocardial disorders that are characterized by ventricular dilation and depressed myocardial contractility in the absence of abnormal loading conditions (such as hypertension or valvular disease) or ischemic heart disease.Angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs) and -blockers are the mainstay of treatment in patients with heart failure, irrespective of the etiology and severity of heart failure. ACEI/ARBs and -blockers have been shown to reverse left ventricular (LV) remodeling and improve dyspnea and exercise tolerance, reduce hospitalization rates, and reduce cardiovascular mortality.The prognosis of dilated cardiomyopathy (DCM) has been poor in the past, 1,2 but has improved since ACEI/ARBs Circulation Journal Vol.70, January 2006and -blockers have been widely used as treatment. Azuma et al reported that in Japan the calculated survival rate at 5 years was 90.0% in patients diagnosed with DCM after 1990 in contrast to 62.3% in patients diagnosed before 1989. 3 However, there are still some cases that remain difficult to treat despite the use of ACEI/ARBs and -blockers, and for these biventricular pacing or surgical interventions, such as heart transplantation or the Batista procedure, has been performed. Therefore, risk prediction in patients with NIDCM is crucial for selection of the best treatment strategy, but there were few reports restricted to cases of NIDCM for examining the predictive factors of heart failure.The purpose of this study was to evaluate various factors that might predict an adverse outcome in patients with NIDCM who were treated with ACEI/ARBs and/orblockers. Methods Patient SelectionWe identified 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was diagnosed by echocardiography, coronary angiography, and endomyocardial biopsy, according to the criteria proposed by the WHO/ISFC task force. NIDCM was defined as LV ejection fraction (LVEF) <0.40, a LV end-diastolic diameter (LVEDD) >55 mm on echocardiography, and the absence of significant coronary artery stenosis on angiography. Exclusion Background The goal of the present study was to identify predictors of event-free survival in nonischemic dilated cardiomyopathy (NIDCM) patients after administration of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and -blockers. Methods and ResultsThe study group comprised 78 consecutive patients with NIDCM between 1997 and 2002. NIDCM was defined as ejection fraction (EF) <0.40 and left ventricular end-dias...

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Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dysfunction in patients with heart failure. SOLVD Investigators.

Abstract: In patients with heart failure and reduced LVEF, chronic ACE inhibition with enalapril prevents progressive LV dilatation and systolic dysfunction (increased ESV). These effects probably result from a combination of altered remodeling and sustained reduction in preload and afterload.

Cited by 496 publications

References 35 publications

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

Significance of myocardial tenascin‐C expression in left ventricular remodelling and long‐term outcome in patients with dilated cardiomyopathy

Prolonged QRS Duration and Severity of Mitral Regurgitation are Unfavorable Prognostic Markers of Heart Failure in Patients With Nonischemic Dilated Cardiomyopathy

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