Prevalence, predictors, and prognosis of reversal of maladaptive remodeling with intensive medical therapy in idiopathic dilated cardiomyopathy

Kawai, Keisuke; Takaoka, Hideyuki; Hata, Katsuya; Yokota, Yoshiyuki; Yokoyama, Mitsuhiro

doi:10.1016/s0002-9149(99)00414-2

Cited by 60 publications

(45 citation statements)

References 29 publications

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“…16 This is not to de-emphasize the important role of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and ␤-blockers, without which patients develop progressive LV dilatation, distortion of LV shape, and deteriorating function that culminates in worsening HF or arrhythmic death. 19,20 Little is known about the potential use of CRT in patients with NYHA class I/II HF. 6 REVERSE demonstrated for the first time in a large, multicenter, randomized, double-blind, controlled study that CRT results in significant LV reverse remodeling, with changes in LV volumes and LVEF in NYHA class I/II HF patients comparable to those seen in NYHA class III/IV patients.…”

Section: St John Sutton Et Al Crt In Mild and Asymptomatic Heart Faimentioning

confidence: 99%

Cardiac Resynchronization Induces Major Structural and Functional Reverse Remodeling in Patients With New York Heart Association Class I/II Heart Failure

et al. 2009

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on Behalf of the REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) Study GroupBackground-Cardiac resynchronization therapy (CRT) improves LV structure, function, and clinical outcomes in New York Heart Association class III/IV heart failure with prolonged QRS. It is not known whether patients with New York Heart Association class I/II systolic heart failure exhibit left ventricular (LV) reverse remodeling with CRT or whether reverse remodeling is modified by the cause of heart failure. Methods and Results-Six hundred ten patients with New York Heart Association class I/II heart failure, QRS duration Ն120 ms, LV end-diastolic dimension Ն55 mm, and LV ejection fraction Յ40% were randomized to active therapy (CRT on; nϭ419) or control (CRT off; nϭ191) for 12 months. Doppler echocardiograms were recorded at baseline, before hospital discharge, and at 6 and 12 months. When CRT was turned on initially, immediate changes occurred in LV volumes and ejection fraction; however, these changes did not correlate with the long-term changes (12 months) in LV end-systolic (rϭ0.11, Pϭ0.31) or end-diastolic (rϭ0.10, Pϭ0.38) volume indexes or LV ejection fraction (rϭ0.07, Pϭ0.72). LV end-diastolic and end-systolic volume indexes decreased in patients with CRT turned on (both PϽ0.001 compared with CRT off), whereas LV ejection fraction in CRT-on patients increased (PϽ0.0001 compared with CRT off) from baseline through 12 months. LV mass, mitral regurgitation, and LV diastolic function did not change in either group by 12 months; however, there was a 3-fold greater reduction in LV end-diastolic and end-systolic volume indexes and a 3-fold greater increase in LV ejection fraction in patients with nonischemic causes of heart failure. Conclusions-CRT in patients with New York Heart Association I/II resulted in major structural and functional reverse remodeling at 1 year, with the greatest changes occurring in patients with a nonischemic cause of heart failure. CRT may interrupt the natural disease progression in these patients.

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Section: St John Sutton Et Al Crt In Mild and Asymptomatic Heart Faimentioning

confidence: 99%

Cardiac Resynchronization Induces Major Structural and Functional Reverse Remodeling in Patients With New York Heart Association Class I/II Heart Failure

et al. 2009

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“…10 Reverse remodelling by ACE inhibitors and, in particular, beta-blockers 11,12 have been linked to reduced morbidity and mortality in all classes of systolic heart failure. Reverse remodelling is a consistent finding in the CRT trials of patients with moderate-to-severe heart failure and wide QRS.…”

Section: Reverse Left Ventricular Remodellingmentioning

confidence: 99%

Cardiac resynchronization therapy: clinical results and evolution of candidate selection

Leclercq¹,

Bleeker²,

Linde³

et al. 2007

European Heart Journal Supplements

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Cardiac resynchronization therapy (CRT) is now a recommended treatment in patients with severe heart failure, a poor left ventricular (LV) ejection fraction and wide QRS of .120 ms. The implementation of CRT in the current guidelines for the treatment of chronic heart failure occurred after the results of different clinical trials including more than 4000 patients, especially the COMPANION and CARE-HF trials. These trials showed that CRT over and above optimal drug treatment improves symptoms, quality of life, exercise tolerance, but more importantly reduces mortality and morbidity. Another major finding was that CRT reverses LV remodelling, a major prognostic factor in heart failure. However, the rate of responders remains only 65-70%. So far, the only validated criterion of cardiac dyssynchrony is the QRS width on the surface ECG, which is probably not optimal. Echocardiographic techniques have shown interesting perspectives for optimizing patient selection, but still have to be validated. Moreover, new indications for CRT (patients with atrial fibrillation, narrow QRS, or mild heart failure) will probably be validated in the near future. The recent and future technical developments in the device will help to optimize the therapy and also to improve heart failure monitoring using sensors in the device and home monitoring by telephone or Internet.

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“…[15][16][17] Also, in patients with sinus rhythm, transmitral peak flow velocities and deceleration time were measured as detailed earlier. 8) Statistical analysis: Group averages are expressed as the mean ± SD. Differences were considered significant at a value of P < 0.05.…”

Section: Vol 46 Nomentioning

confidence: 99%

“…5,6) Moreover, we and other researchers recently reported that reverse ventricular remodeling with neurohormonal antagonism in heart failure was associated with a better clinical outcome. 7,8) The purposes of this study were 1) to determine whether the presence of HCV infection in DCM patients is more than coincidental, using control patients with other heart diseases in a well-defined area because of the various prevalences of HCV infection in the general population from place to place, 2,9,10) 2) to elucidate the pathophysiological effects of HCV infection in DCM patients, and 3) to compare the responsiveness to neurohormonal antagonism and prognosis between DCM with and without HCV. (Table I) : A total of 135 consecutive DCM patients who entered our institutes from 1993 to 2000 and provided informed consent were examined.…”

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confidence: 99%

Pathophysiological Characteristics and Responsiveness to Neurohormonal Antagonism in Idiopathic Dilated Cardiomyopathy Patients With Antihepatitis C Virus Antibody

et al. 2005

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SUMMARYA high prevalence of hepatitis C virus (HCV) infection has been reported among idiopathic dilated cardiomyopathy (DCM) patients. We examined the prevalence of DCM patients with HCV antibody, and the pathophysiological characteristics and responsiveness to neurohormonal antagonism in DCM with HCV. HCV antibodies were determined in 540 patients with cardiac diseases. In 117 DCM patients, clinicopathologic data were evaluated before and 1 year after angiotensin converting enzyme inhibitor and/or betablocker (ACE-inhibitor/BB) administration and their prognosis was followed-up for a mean of 72 ± 41 months. HCV antibodies were found in 12 of 135 DCM patients (8.9%) and in 37 of 405 patients without DCM (9.1%) (P = NS). At baseline, contrary to DCM without HCV, DCM with HCV was associated (P < 0.05) with greater left ventricular (LV) end-diastolic and end-systolic dimension, LV mass, and myocardial diameter in endomyocardial biopsy, and lower % fractional shortening. By multivariate analysis, HCV infection was independently associated with larger LV end-systolic dimension among DCM patients (P = 0.005). The advanced LV dilatation and hypertrophy in DCM with HCV decreased more in response to the ACE-inhibitor/BB therapy compared to DCM without HCV. There were no differences between DCM patients with and without HCV in survival and cardiac event-free rates. In summary, although HCV infection appears not to be the specific cause of DCM, HCV may enhance ventricular remodeling leading to heart failure among DCM patients. Nevertheless, the advanced ventricular remodeling with HCV was adequately reversed by neurohormonal antagonism, and did not lead to an unfavorable outcome. (Int Heart J 2005; 46: 407-417)

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Prevalence, predictors, and prognosis of reversal of maladaptive remodeling with intensive medical therapy in idiopathic dilated cardiomyopathy

Cited by 60 publications

References 29 publications

Cardiac Resynchronization Induces Major Structural and Functional Reverse Remodeling in Patients With New York Heart Association Class I/II Heart Failure

Cardiac Resynchronization Induces Major Structural and Functional Reverse Remodeling in Patients With New York Heart Association Class I/II Heart Failure

Cardiac resynchronization therapy: clinical results and evolution of candidate selection

Pathophysiological Characteristics and Responsiveness to Neurohormonal Antagonism in Idiopathic Dilated Cardiomyopathy Patients With Antihepatitis C Virus Antibody

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