Persistence of Restrictive Left Ventricular Filling Pattern in Dilated Cardiomyopathy: An Ominous Prognostic Sign

AbstractObjectives. We sought to assess the prognostic implications of the evolution of restrictive left ventricular filling pattern (RFP) in dilated cardiomyopathy (DCM).Background. Previous work has demonstrated that a RFP in DCM is associated with a poor prognosis. Few data are available on the prognostic implications of the evolution of this pattern.Methods. The evolution of left ventricular filling was studied by Doppler echocardiography in 110 patients with DCM. According to the left ventricular filling pattern at presentation and after 3 months of treatment, the patients were classified into three groups: Group 1A (n = 24) had persistent restrictive filling; Group 1B (n = 29) had reversible restrictive filling; and Group 2 (n = 57) had nonrestrictive filling.Results. During follow-up (41 ± 20 months), mortality plus heart transplantation was significantly higher in Group 1A than in Groups 1B and 2 (p < 0.0001). On multivariate analysis, the model incorporating E wave deceleration time at 3 months was more powerful at predicting mortality with respect to this variable at baseline (p = 0.0039). Clinical improvement at 1 and 2 years was significantly more frequent in Groups 1B and 2 than in Group 1A (p < 0.0001 at 2 years).Conclusions. In patients with DCM, the persistence of restrictive filling at 3 months is associated with a high mortality and transplantation rate. The patients with reversible restrictive filling have a high probability of improvement and excellent survival. Doppler echocardiographic reevaluation of these patients after 3 months of therapy gives additional prognostic information with respect to the initial study.(J Am Coll Cardiol 1997;29:604–12

Genetic CardiomyopathiesA Clinical Approach /

XI, 166 p.online resource

DEFINITION, CLASSIFICATION, EPIDEMIOLOGY, AND CLINICAL RELEVANCE OF CARDIOMYOPATHIES.

7Historically, in the first classification the term "Cardiomyopathy" [CMP] was used to describe a heart muscle disease of unknown cause, whereas heart muscle disorders of known etiology [such as coronary artery disease, valvular disease or hypertension] or those associated with systemic diseases were classified as specific CMP. With scientific progress [in particular in genetics and in biotechnology] it became more and more difficult to distinguish between CMP and specific heart muscle disease [primary and secondary CMP] as it was possible to understand the etiologic basis and pathophysiologic pathways of many so-called "idiopathic" heart muscle disorders. Therefore, in the last years important advances have been made to re-define and re-classify CMP.nonenoneMerlo, Marco; Spezzacatene, Anita; Brun, Francesca; Lenarda, Andrea Di; Bussani, Rossana; Sinagra, Gianfranco; Camerini, Fulvio .Merlo, Marco; Spezzacatene, Anita; Brun, Francesca; Lenarda, Andrea Di; Bussani, Rossana; Sinagra, Gianfranco; Camerini, Fulvio

Long-term effects of carvedilol in idiopathic dilated cardiomyopathy with persistent left ventricular dysfunction despite chronic metoprolol

AbstractOBJECTIVESThe purpose of this study was to analyze whether long-term treatment with the nonselective beta-adrenergic blocking agent carvedilol may have beneficial effects in patients with dilated cardiomyopathy (DCM), who are poor responders in terms of left ventricular (LV) function and exercise tolerance to chronic treatment with the selective beta-blocker metoprolol.BACKGROUNDAlthough metoprolol has been proven to be beneficial in the majority of patients with heart failure, a subset of the remaining patients shows long-term survival without satisfactory clinical improvement.METHODSThirty consecutive DCM patients with persistent LV dysfunction (ejection fraction ≤40%) and reduced exercise tolerance (peak oxygen consumption <25 ml/kg/min) despite chronic (>1 year) tailored treatment with metoprolol and angiotensin-converting enzyme inhibitors were enrolled in a 12-month, open-label, parallel trial and were randomized either to continue on metoprolol (n = 16, mean dosage 142 ± 44 mg/day) or to cross over to maximum tolerated dosage of carvedilol (n = 14, mean dosage 74 ± 23 mg/day).RESULTSAt 12 months, patients on carvedilol, compared with those continuing on metoprolol, showed a decrease in LV dimensions (end-diastolic volume −8 ± 7 vs. +7 ± 6 ml/m2, p = 0.053; end-systolic volume −7 ± 5 vs. +6 ± 4 ml/m2, p = 0.047), an improvement in LV ejection fraction (+7 ± 3% vs. −1 ± 2%, p = 0.045), a reduction in ventricular ectopic beats (−12 ± 9 vs. +62 ± 50 n/h, p = 0.05) and couplets (−0.5 ± 0.4 vs. +1.5 ± 0.6 n/h, p = 0.048), no significant benefit on symptoms and quality of life and a negative effect on peak oxygen consumption (−0.6 ± 0.6 vs. +1.3 ± 0.5 ml/kg/min, p = 0.03).CONCLUSIONSIn DCM patients who were poor responders to chronic metoprolol, carvedilol treatment was associated with favorable effects on LV systolic function and remodeling as well as on ventricular arrhythmias, whereas it had a negative effect on peak oxygen consumption

Blood bank preparedness for mass casualty incidents and disasters: a pilot study in the Piedmont region, Italy

Blood is a critical resource for responding to mass casualty incidents (MCI). The main framework for transfusion preparedness is the American Association of Blood Bank (AABB) Disaster Operation Handbook. A disaster preparedness plan for co-ordinated blood supply was issued in Italy in 2016

Blood bank preparedness for mass casualty incidents and disasters: a pilot study in the Piedmont region, Italy

Blood is a critical resource for responding to mass casualty incidents (MCI). The main framework for transfusion preparedness is the American Association of Blood Bank (AABB) Disaster Operation Handbook. A disaster preparedness plan for co-ordinated blood supply was issued in Italy in 2016