Long-Term Prognosis of Dilated Cardiomyopathy Revisited An Improvement in Survival Over the Past 20 Years

Abstract

diopathic dilated cardiomyopathy had a poor prognosis in the past. [1][2][3][4][5] Many randomized clinical trials performed in the United States of America and Europe have shown the beneficial effects of angiotensin converting enzyme inhibitors (ACEI), [6][7][8][9] angiotensin II receptor blockers (ARB) [10][11][12][13] and blockers on the survival of the patients with congestive heart failure. [14][15][16][17][18][19] In contrast, only 2 small randomized studies of ARB (candesartan) 20 and blocker (carvedilol) have been performed in Japan to date in patients with congestive heart failure. 21 There are no randomized studies of ACEI.Although there are few reports concerning the long-term prognosis of Japanese patients with dilated cardiomyopathy (DCM) after ACEI, ARB and blockers became major components of background therapy in the management of all stages of patients with DCM, the beneficial effects of ACEI/ARB and blockers on the prognosis of Japanese patients with DCM have not clearly been shown in these studies. [22][23][24][25][26][27][28] Some studies even failed to reveal favorable effects of ACEI or blockers on the survival of Japanese patients with DCM. 23,27,28 It also remains uncertain whether antiarrhythmics 23,29 or spironolactone have significant effects on the prognosis of Japanese patients with DCM,23 though previous studies in Western countries have shown an adverse effect of antiarrhythmics 30-34 and a favorable effect of spironolactone on the prognosis. 35 Thus, little information exists concerning changes in the prognosis of Japanese patients with DCM, to whom the recent trend in the survival should be informed, in relation to treatment.The purpose of the presemt study was to analyze the changes in the long-term prognosis in Japanese patients with DCM over the past 20 years and to identify the factors that might have influenced survival. Methods Study PatientsWe studied 150 patients (115 men and 35 women, aged 20-83 (mean =59±11) years) with idiopathic DCM who were referred to our hospital between 1982 and 2002. Ninety patients were in the New York Heart Association functional class I or II, and 60 patients were in class III or IV. A careful history was taken from all the patients, and they were given a physical examination, blood test, chest X ray, standard echocardiography, exercise stress test and cardiac catheterization, including coronary angiography and biplane left ventriculography. The diagnostic criteria were: (1) a dilated left ventricle (end-diastolic dimension (LVDd) >55 mm) with fractional shortening (LVFS) <25%; and (2) exclusion of patients with acute myocarditis, specific heart muscle disease, general systemic disease, significant coronary artery stenosis (defined as diameter narrowing of >50% in any of the major coronary arteries or their Background Because of their favorable prognostic effects, angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) and blockers have become background therapy in dilated cardiomyopathy (DCM). However, there ar...

Prediction of left ventricular reverse remodeling after therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and β blockers in patients with idiopathic dilated cardiomyopathy

“…A low dose of carvedilol of 5 mg/day was beneficial in Japanese patients with heart failure in the Multicenter Carvedilol Heart Failure Dose Assessment (MUCHA) trial [ 26 ]. We have previously reported that low doses of ACE inhibitors, ARBs, and β blockers had favorable effects on the prognosis of Japanese patients with IDC [ 27 , 28 ]. The Japanese Guidelines (available at the Japanese Circulation Society Web site ( http://www.j-circ.or.jp/ ) have recommended a targeting dose of enalapril of 5 to 10 mg/day and of carvedilol of 5 to 20 mg/day.…”

Myocarditis in Humans and in Experimental Animal Models

“…DCM patients develop not only heart pump weakening, but also heart valve problems, blood clots, and arrhythmias leading to heart and secondary organ failures. DCM patients show transplantation-free survival at the rate of 50–60% over 5 years in children (15) and in adults (7, 16, 17), however improved medication can increase the survival rate up to 80% (16). Particularly high mortality has been reported for patients with DCM due to Chagas disease (17).…”

The DuraHeart VAD, a Magnetically Levitated Centrifugal Pump The University of Vienna Bridge-to-Transplant Experience

“…The DuraHeart is expected to be one of the options for improving the prognosis of severe heart failure patients by enabling reliable long-term circulatory support. 12,13 It is still debatable which type of rotary pump, axial or centrifugal, including the magnetically levitated DuraHeart, is preferable for application in patients requiring higher pump flows and/or long-term support. Recently, some axial pumps have achieved circulatory assistance for more than 2 years.…”