Influence of co-existing atrial fibrillation on the efficacy of atorvastatin treatment in patients with dilated cardiomyopathy: a pilot study

Bielecka‐Dąbrowa, Agata; Goch, Jan Henryk; Rysz, Jacek; Maciejewski, Marek; Desai, Ravi V.; Aronow, Wilbert S.; Banach, Maciej

doi:10.1186/1476-511x-9-21

Cited by 10 publications

(10 citation statements)

References 30 publications

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“…By single-factor analysis, they found that the follow-up mortality was 17% in the statin group and it was significantly lower than the 37% mortality of non-statin users ( p = 0.003); in patients with worsening cardiac function NYHA III-IV, the mortality of the statin group was 17% while a much higher mortality of 47% was found in non-statin users ( p = 0.003). The authors concluded that early treatment with atorvastatin or simvastatin was closely correlated with the reduction of mortality in nonischemic dilated cardiomyopathy patients, which is consistent with our findings [60-62]. Our findings of better survival in the atorvastatin group are consistent with Vrtovec et al [14], Domanski et al [45] and Li et al [60] and may support the underlying mechanism described by Buber et al [49] and Tsutamoto et al [55].…”

Section: Discussionsupporting

confidence: 91%

“…Therefore, the increase in LVEF observed in the atorvastatin group may be partly related to an improvement of the oxidative stress in the myocardium. Li et al [60] explored the effect of early statin therapy (atorvastatin and simvastatin) on mortality in patients with nonischemic DCM. A total of 315 patients with nonischemic DCM were enrolled.…”

Section: Discussionmentioning

confidence: 99%

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The influence of atorvastatin on parameters of inflammation left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy – 5-year follow-up

et al. 2013

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BackgroundWe assessed the influence of atorvastatin on selected indicators of an inflammatory condition, left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy (DCM).MethodsWe included 68 DCM patients with left ventricular ejection fraction (LVEF) ≤40% treated optimally in a prospective, randomized study. They were observed for 5 years. Patients were divided into two groups: patients who were commenced on atorvastatin 40 mg daily for two months followed by an individually matched dose of 10 or 20 mg/day (group A), and patients who were treated according to current recommendations without statin therapy (group B).ResultsAfter 5-year follow-up we assessed 45 patients of mean age 59 ± 11 years - 22 patients in group A (77% male) and 23 patients in group B (82% male). Interleukin-6, tumor necrosis factor alpha, and uric acid concentrations were significantly lower in the statin group than in group B (14.96 ± 4.76 vs. 19.02 ± 3.94 pg/ml, p = 0.012; 19.10 ± 6.39 vs. 27.53 ± 7.39 pg/ml, p = 0.001, and 5.28 ± 0.48 vs. 6.53 ± 0.46 mg/dl, p = 0.001, respectively). In patients on statin therapy a reduction of N-terminal pro-brain natriuretic peptide concentration (from 1425.28 ± 1264.48 to 1098.01 ± 1483.86 pg/ml, p = 0.045), decrease in left ventricular diastolic (from 7.15 ± 0.90 to 6.67 ± 0.88 cm, p = 0.001) and systolic diameters (from 5.87 ± 0.92 to 5.17 ± 0.97, p = 0.001) in comparison to initial values were observed. We also showed the significant increase of LVEF in patients after statin therapy (from 32.0 ± 6.4 to 38.8 ± 8.8%, p = 0.016). Based on a comparison of curves using the log-rank test, the probability of survival to 5 years was significantly higher in patients receiving statins (p = 0.005).ConclusionsAtorvastatin in a small dose significantly reduce levels of inflammatory cytokines and uric acid, improve hemodynamic parameters and improve 5-year survival in patients with DCM.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

The influence of atorvastatin on parameters of inflammation left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy – 5-year follow-up

et al. 2013

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“…Dilated left ventricle has a larger left atrial appendage and seems to be at a higher risk for thrombus formation (Bakalli et al, 2010). Patients with DCM and co-existing AF have shown a weaker effect of 3-hydroxy-3-methylglutaryl coenzyme A inhibitor concerning the reduction of IL-6 and NT-proBNP concentration to inhibit remodeling of the myocardium (Bielecka-Dabrowa et al, 2010). Conduction block occurred at a rate of up to 45% in DCM patients, including the atrioventricular node block and bundle branch block, because diffuse cardiac damage in DCM patients is involved in conduction system.…”

Section: Discussionmentioning

confidence: 99%

Torasemide reduces dilated cardiomyopathy, complication of arrhythmia, and progression to heart failure

Han¹,

Guo²,

Lin³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to analyze the incidence and types of arrhythmia and their relationship with the severity and prognosis of chronic heart failure (CHF) in patients with dilated cardiomyopathy (DCM), and to investigate the therapeutic effect of torasemide versus furosemide on CHF and incidence of arrhythmia. DCM patients with NYHA cardiac function II-IV were continuously monitored using a 24-h dynamic electrocardiogram (Holter), and arrhythmia incidence was analyzed by computer automatic analysis combined with manual assessment. In total, 125 participants were evenly divided into two groups: torasemide group which received 10 mg oral torasemide once daily) and regular anti-heart failure treatment (N = 65), and furosemide group which received torasemide (20 mg once daily orally) and regular antiheart failure treatment (N = 60). Another 60 normal healthy persons served as the normal control group. Incidence and severity of arrhythmia increased when degree of CHF was elevated. Size of left atrium was related to atrial fibrillation and size of left ventricle was related to malignant arrhythmia. At 3 months after treatment, cardiac function in both groups improved and incidence and severity of arrhythmia in both groups were reduced. However, left ventricular ejection fraction (LVEF) was higher in the torasemide group than in the furosemide group, while incidence of arrhythmia was lower in the torasemide group. Arrhythmias frequently occurred in patients with DCM and HF. Type of cardiac arrhythmia is closely related to ventricular enlargement and cardiac function grade. Torasemide is better for improving cardiac function to reduce arrhythmia and CHF compared to furosemide.

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“…In the analyzed population, increase in the proBNP level was more related to heart valve disease progression and grade of ventricular dysfunction than to atrial enlargement leading to POAF. This would explain the ineffectiveness of atorvastatin in POAF prevention and the conflicting results with previous studies about the influence of atorvastatin in reducing N‐terminal‐proBNP in patients affected by dilated cardiomyopathy [31,35].…”

Section: Discussionmentioning

confidence: 74%

Efficacy of atorvastatin in prevention of atrial fibrillation after heart valve surgery in the PROFACE trial (PROphylaxis of postoperative atrial Fibrillation After Cardiac surgEry)

Carrascal

Arnold²,

Fuente³

et al. 2016

Journal of Arrhythmia

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BackgroundTo evaluate the efficacy of perioperative atorvastatin administration for prophylaxis of postoperative atrial fibrillation (POAF) after heart valve surgery.MethodsOur study included 90 patients with heart valve disease who were scheduled to undergo elective cardiac surgery. Cases with previous AF or preoperative beta-blocker therapy were excluded. Patients were randomized into the atorvastatin group, which included 47 patients who received 40 mg/day of atorvastatin 7 days before and after the surgery and the control group, which included 43 patients. Primary endpoint was the occurrence of POAF. Secondary endpoints included modifications in the preoperative and postoperative levels of the markers of inflammation (C-reactive protein [CRP]), myocardial injury (ultrasensitive troponin T and creatinine phosphokinase MB [CPK-MB]), and cardiac dysfunction (pro-brain natriuretic peptide [proBNP]) related to POAF and changes in the echocardiographic parameters, such as atrial electromechanical interval, A wave, E/A ratio, and Doppler imaging systolic velocity wave amplitude, related to POAF.ResultsNo relationship between atorvastatin administration and reduction in the incidence of POAF was observed (42.6% in the atorvastatin vs. 30.2% in the control group) (p=0.226). No difference in the levels of CPK-MB, ultrasensitive troponin T, CRP, or proBNP and in the analyzed echocardiographic parameter was detected between both groups.ConclusionsAtorvastatin in the described dose, was not adequate for the prophylaxis of POAF after heart valve surgery. It was ineffective in controlling the inflammatory phenomena, myocardial injury, and echocardiographic predictors of POAF.

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Influence of co-existing atrial fibrillation on the efficacy of atorvastatin treatment in patients with dilated cardiomyopathy: a pilot study

Cited by 10 publications

References 30 publications

The influence of atorvastatin on parameters of inflammation left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy – 5-year follow-up

The influence of atorvastatin on parameters of inflammation left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy – 5-year follow-up

Torasemide reduces dilated cardiomyopathy, complication of arrhythmia, and progression to heart failure

Efficacy of atorvastatin in prevention of atrial fibrillation after heart valve surgery in the PROFACE trial (PROphylaxis of postoperative atrial Fibrillation After Cardiac surgEry)

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