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Managing advanced heart failure in Duchenne muscular dystrophy
Progress in Pediatric Cardiology xxx (xxxx) xxxx
Contents lists available at ScienceDirect
Progress in Pediatric Cardiology journal homepage: www.elsevier.com/locate/ppedcard
Managing advanced heart failure in Duchenne muscular dystrophy Abdallah Fayssoil Pitié Salpetriere Hospital, Myology Institute, Paris, France
A B S T R A C T
Advanced heart failure in Duchenne muscular dystrophy is a comprise situation in clinical practice. Identifying patients that may benefit from left ventricular assist device (LVAD) or heart transplantation (HTX) is challenging. In addition with the cardiac function status, it is essential to clarify the respiratory status and the electrical aspects.
I read with great interest the paper by Wittlieb-Weber [1] about the innovative uses of advanced heart failure therapies in Duchenne muscular dystrophy (DMD). As outlined by the authors, selecting a DMD candidate for left ventricular assist device (LVAD) and heart transplantation is extremely challenging and must take into account many competing factors. DMD patients with complete left bundle branch block with heart failure can benefit from cardiac resynchronization therapy (CRT) which may improve cardiac function [2]. Among the 436 patients included in the study [1], it is essential to know the prevalence of complete left bundle branch block and its management. Also, among patients with an implantable cardioverter defibrillator (ICD), it may be important to know the number of patients who have undergone resynchronization therapy. Finally, the respiratory function and functional physical status of the patient is a key determinant for selecting a DMD candidate with severe heart failure who will benefit the most from a LVAD or heart transplantation [3]. It is important to appreciate the impact of further therapies on the respiratory physiology of DMD patients and how to plan for its management prior to further invasive interventions. Finally, it would be valuable to know how many patients
after the surgical intervention required chronic mechanical ventilation or a definitive tracheostomy? This information will assist the decision making and consent processes for the best management of DMD patients with advanced heart failure. Declaration of competing interest The author has no conflicts of interest to declare. References [1] Wittlieb-Weber CA, Villa CR, Conway J, Bock MJ, Gambetta KE, Johnson JN, et al. Use of advanced heart failure therapies in Duchenne muscular dystrophy. Prog Pediatr Cardiol 2019 Jun;53:11–4. [2] Fayssoil A, Nardi O, Annane D, Orlikowski D. Successful cardiac resynchronisation therapy in Duchenne muscular dystrophy: a 5-year follow-up. Presse Med 2014 Mar;43(3):330–1. [3] Stoller D, Araj F, Amin A, Fitzsimmons C, Morlend R, Thibodeau JT, et al. Implantation of a left ventricular assist device to provide long-term support for endstage Duchenne muscular dystrophy-associated cardiomyopathy. ESC Heart Fail 2017 Aug;4(3):379–83.
E-mail address: [email protected]. https://doi.org/10.1016/j.ppedcard.2019.101148 Received 8 August 2019; Received in revised form 30 August 2019; Accepted 6 September 2019 1058-9813/ © 2019 Elsevier B.V. All rights reserved.
Please cite this article as: Abdallah Fayssoil, Progress in Pediatric Cardiology, https://doi.org/10.1016/j.ppedcard.2019.101148
Contents lists available at ScienceDirect
Progress in Pediatric Cardiology journal homepage: www.elsevier.com/locate/ppedcard
Managing advanced heart failure in Duchenne muscular dystrophy Abdallah Fayssoil Pitié Salpetriere Hospital, Myology Institute, Paris, France
A B S T R A C T
Advanced heart failure in Duchenne muscular dystrophy is a comprise situation in clinical practice. Identifying patients that may benefit from left ventricular assist device (LVAD) or heart transplantation (HTX) is challenging. In addition with the cardiac function status, it is essential to clarify the respiratory status and the electrical aspects.
I read with great interest the paper by Wittlieb-Weber [1] about the innovative uses of advanced heart failure therapies in Duchenne muscular dystrophy (DMD). As outlined by the authors, selecting a DMD candidate for left ventricular assist device (LVAD) and heart transplantation is extremely challenging and must take into account many competing factors. DMD patients with complete left bundle branch block with heart failure can benefit from cardiac resynchronization therapy (CRT) which may improve cardiac function [2]. Among the 436 patients included in the study [1], it is essential to know the prevalence of complete left bundle branch block and its management. Also, among patients with an implantable cardioverter defibrillator (ICD), it may be important to know the number of patients who have undergone resynchronization therapy. Finally, the respiratory function and functional physical status of the patient is a key determinant for selecting a DMD candidate with severe heart failure who will benefit the most from a LVAD or heart transplantation [3]. It is important to appreciate the impact of further therapies on the respiratory physiology of DMD patients and how to plan for its management prior to further invasive interventions. Finally, it would be valuable to know how many patients
after the surgical intervention required chronic mechanical ventilation or a definitive tracheostomy? This information will assist the decision making and consent processes for the best management of DMD patients with advanced heart failure. Declaration of competing interest The author has no conflicts of interest to declare. References [1] Wittlieb-Weber CA, Villa CR, Conway J, Bock MJ, Gambetta KE, Johnson JN, et al. Use of advanced heart failure therapies in Duchenne muscular dystrophy. Prog Pediatr Cardiol 2019 Jun;53:11–4. [2] Fayssoil A, Nardi O, Annane D, Orlikowski D. Successful cardiac resynchronisation therapy in Duchenne muscular dystrophy: a 5-year follow-up. Presse Med 2014 Mar;43(3):330–1. [3] Stoller D, Araj F, Amin A, Fitzsimmons C, Morlend R, Thibodeau JT, et al. Implantation of a left ventricular assist device to provide long-term support for endstage Duchenne muscular dystrophy-associated cardiomyopathy. ESC Heart Fail 2017 Aug;4(3):379–83.
E-mail address: [email protected]. https://doi.org/10.1016/j.ppedcard.2019.101148 Received 8 August 2019; Received in revised form 30 August 2019; Accepted 6 September 2019 1058-9813/ © 2019 Elsevier B.V. All rights reserved.
Please cite this article as: Abdallah Fayssoil, Progress in Pediatric Cardiology, https://doi.org/10.1016/j.ppedcard.2019.101148