Improved Survival of Idiopathic Dilated Cardiomyopathy in the 1990s

Azuma, Akihiro; Matsuo, Akiko; Nakamura, Takashi; Kawasaki, Tatsuya; Yamamoto, Kazuki; Hyogo, Masayuki; Hirata, Atsuhide; Hirasaki, Satoshi; Shima, Takatomo; Sugihara, Hiroki; Kono, Hiroshi; Kuribayashi, Toshiro; Nakagawa, Masao

doi:10.1253/jcj.63.333

Cited by 15 publications

(13 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[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][31][32][33][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.…”

mentioning

confidence: 99%

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

Matsumura

Takata

Kitaoka

et al. 2006

Circ J

View full text Add to dashboard Cite

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...

show abstract

mentioning

confidence: 99%

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

Matsumura

Takata

Kitaoka

et al. 2006

Circ J

View full text Add to dashboard Cite

show abstract

“…3 Clinical evidence has accumulated of the beneficial effect of blockade of 1-AR on cardiac remodeling and prognosis in Circulation Journal Vol.66, August 2002 patients with heart failure caused by DCM or myocardial infarction. 4,5 In the CIBIS-II study, bisoprolol, a highly selective 1-AR blocker, improved the survival rate in patients with heart failure and more importantly, also showed that bisoprolol reduced sudden death most likelycaused by lethal ventricular arrhythmia and hospital admissions for malignant ventricular arrhythmia. 6 The MERIT-HF study showed that metoprolol, a selective 1-AR blocker, also reduced sudden death in patients with heart failure.…”

mentioning

confidence: 99%

“…4,5 In the CIBIS-II study, bisoprolol, a highly selective 1-AR blocker, improved the survival rate in patients with heart failure and more importantly, also showed that bisoprolol reduced sudden death most likelycaused by lethal ventricular arrhythmia and hospital admissions for malignant ventricular arrhythmia. 6 The MERIT-HF study showed that metoprolol, a selective 1-AR blocker, also reduced sudden death in patients with heart failure.…”

mentioning

confidence: 99%

Suppressive Effect of the Gly389 Allele of the .BETA.1-Adrenergic Receptor Gene on the Occurrence of Ventricular Tachycardia in Dilated Cardiomyopathy.

Iwai

Akita

Shiga

et al. 2002

Circ J

View full text Add to dashboard Cite

ilated cardiomyopathy (DCM) is characterized by ventricular dilatation and depressed myocardial contractility, resulting in progressive refractory congestive heart failure and sudden death from ventricular arrhythmias (mainly ventricular tachycardia (VT) and subsequent ventricular fibrillation). 1 A structural increase in ventricular volume (cardiac remodeling) has been viewed as not only an adaptive consequence of initial myocardial damage, but an important determinant of the progression of heart failure. Although risk stratification of cardiac remodeling and ventricular arrhythmias in DCM is an important issue in clinical practice, the factors that lead to cardiac remodeling or induction of VT are not well defined.The adrenergic nervous system, especially through -1-adrenergic receptor ( 1-AR) activation, appears to be of major importance not only in the genesis or progression of cardiac remodeling but also in induction of VT. 2 In transgenic mice, cardiac overexpression of human 1-AR produced an overtly cardiomyopathic phenotype and ultimately chamber dilatation and systolic dysfunction. 3 Clinical evidence has accumulated of the beneficial effect of blockade of 1-AR on cardiac remodeling and prognosis in Circulation Journal Vol.66, August 2002 patients with heart failure caused by DCM or myocardial infarction. 4,5 In the CIBIS-II study, bisoprolol, a highly selective 1-AR blocker, improved the survival rate in patients with heart failure and more importantly, also showed that bisoprolol reduced sudden death most likelycaused by lethal ventricular arrhythmia and hospital admissions for malignant ventricular arrhythmia. 6 The MERIT-HF study showed that metoprolol, a selective 1-AR blocker, also reduced sudden death in patients with heart failure. 7 Accordingly, it seems reasonable to suppose that the signals mediated by 1-AR play an important role in the arrhythmogenesis of heart failure.Beta-1-AR is encoded by a gene comprising a single exon located on chromosome 10q24-26 and consists of 477 amino acids. 8 To date, 18 genetic variants of the single nucleotide chain have been identified. Although 17 of these are located at the coding region, amino acid changes occur only in 7 variants (Ser49Gly, Ala59Ser, Arg389Gly, Arg399Cys, His402Arg, Thr404Ala and Pro418Ala). 9 None of these regions other than the 389 residue have been implicated in the precise function of the 1-AR. The Arg389Gly variant is located at the interface between the last transmembrane helix and the intracellular tail, adjacent to the phosphorylation sites and thought to be critical for Gprotein coupling and subsequent cell signaling. Interestingly, functional studies using transfected fibloblasts indicated that the Arg389 1-AR had approximately 3-fold the adenylyl cyclase activity of the Gly389 1-AR when stimulated by isoproterenol. 10 Therefore, it is quite possible that the Arg389Gly polymorphism functions as either a gene for susceptibility for DCM (role in the emergence of DCM) or a modifier gene (role in the evolution/prognosis Beta-1-ad...

show abstract

“…Recently, -adrenergic blockade has become one of the most effective treatments for patients with chronic heart failure [12][13][14] and long-term use improves left ventricular function. 15,16 -blockers are also able to reduce the incidence of sudden death, as well as death from heart failure, in patients with chronic HF.…”

Section: Discussionmentioning

confidence: 99%

Changes in the Occurrence of Mechanical Alternans After Long-Term β-Blocker Therapy in Patients With Chronic Heart Failure

et al. 2001

View full text Add to dashboard Cite

echanical alternans is a mysterious phenomenon of alternating strong and weak beats with a constant beat-to-beat interval 1,2 that has been observed in patients with severe congestive heart failure (HF) caused by global left ventricular dysfunction. Other conditions related to the appearance of mechanical alternans are HF associated with aortic stenosis or hypertrophic obstructive cardiomyopathy, sudden increase of afterload, severe ischemia, abrupt fall of preload and the onset of a tachyarrhythmia. Its origin and clinical implications are obscure, although several experimental studies have suggested that mechanical alternans is associated with abnormal intracellular Ca ++ cycling in the cardiomyocytes. [3][4][5] The precise frequency of mechanical alternans in patients with chronic HF is unknown, although in 1915, White used radial pulse tracing and reported that 71 of 300 patients exhibited mechanical alternans, either decay or sustained alternans. 6 Because 25 of the 71 cases with mechanical alternans died within 10 months, it was, and has been, considered a predictor of poor prognosis in patients with heart disease. Therapeutic strategies were limited at that time, but it has not been well established whether patients showing mechanical alternans can be effectively controlled by recent therapeutic strategies, such as angiotensin convertJapanese Circulation Journal Vol.65, August 2001 ing enzymes and -blockers.The present study investigated the occurrence of mechanical alternans before and after long-term -blocker therapy in patients with chronic HF. Methods PatientsSeventeen patients who had their cardiac function assessed twice by cardiac catheterization were included (Table 1); patients with active myocarditis, significant valvular heart disease or with ischemic heart disease were excluded. Nine patients had sinus rhythm and the remainder had atrial fibrillation. After admission to hospital, the congestive HF was controlled with diuretics, digitalis and angiotensin-converting enzyme inhibitors. The cardiac catheterization studies were performed after written informed consent was obtained from each patient. Hemodynamic AssessmentAll patients initially underwent routine left and right diagnostic catheterization using a femoral approach. The diagnostic examination comprised pressure studies, coronary arteriography and left ventriculography, after which a 7Fr micromanometer tipped pig-tail catheter (Miller Industries, Houston, TX, USA) was placed in the left ventricle. A 5Fr pacing catheter was advanced to the right atrium in patients with sinus rhythm and to the right ventricle in patients with atrial fibrillation. Mechanical alternans has been observed in patients with severe congestive heart failure, and the phenomenon is considered to be a terminal sign. Therapeutic strategies for chronic heart failure have significantly developed, but it is uncertain whether patients with mechanical alternans can be effectively treated or not. Seventeen consecutive patients with dilated cardiomyopathy were enrolled: 1...

show abstract

Improved Survival of Idiopathic Dilated Cardiomyopathy in the 1990s

Cited by 15 publications

References 18 publications

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

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

Suppressive Effect of the Gly389 Allele of the .BETA.1-Adrenergic Receptor Gene on the Occurrence of Ventricular Tachycardia in Dilated Cardiomyopathy.

Changes in the Occurrence of Mechanical Alternans After Long-Term β-Blocker Therapy in Patients With Chronic Heart Failure

Contact Info

Product

Resources

About