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Recent Topics in Dilated Cardiomyopathy
S268
Journal of Cardiac Failure Vol. 11 No. 9 Suppl. 2005
EL5 Recent Topics in Dilated Cardiomyopathy TOHRU IZUMI Kitasato University, Sagamihara, Japan In field of dilated cardiomyopathy, we are now standing on a new paradigm. Historically, beta blocker therapy has clearly altered the fate of the patient with this disease. The patients with dilated cardiomyopathy, who are well responsive to this agent, are very well protected against remission. Most of them would be able to complete their lives without any difficulties if they would not stop taking it. In contrast, for patients who scarcely react to it, the prognosis is very poor. Their fate is very similar to patients of the past. From such a point of view, dilated cardiomyopathy refractory to beta blocker is an important issue in clinical medicine. How to make a proper diagnosis of chronic myocarditis, that is inflammatory cardiomyopathy, is now necessary. Cardiac imaging using magnetic resonance is a hopeful and strong answer concerning this issue. A combined approach of T2-weighted imaging and gadolinium enhancement provides us with the devices which have a high diagnostic value in the disease. Even if patients are positive in resonance imaging, endomyocardial biopsies are required to establish the final diagnosis. For patients with inflammatory cardiomyopathy, who are refractory to conventional therapy including beta-blockers, immuno-modulators are applied. As a result, half of them are responsive to this therapy. Out of 90%, autoantibodies against the heart are detected. Meanwhile, in 85% of the other not-responsive patients, virus genomes can be found. It will be assumed that if autoimmune myocarditis and cardiomyopathy could be really diagnosed, such immuno-modulators would be working well. Beside, as an experimental lesson, it has already been revealed that autoimmune myocarditis and cardiomyopathy might be worsened by beta blocker therapy. To differentiate the autoimmune disease and consider beta blocker use, magnetic resonance imaging can be very helpful. In dilated cardiomyopathy with advanced heart failure, the main concern has been focused on the LV function but not on RV function. This tendency that RV function has only a limited contribution to the assessment of this disease must be stopped. The RV dysfunction has been well known to be a powerful predictor of reduced exercise capacity and survival. Especially, despite better therapy, the prognosis of patients who show high pulmonary artery pressure and low RV ejection fraction is limited. Accordingly, the serum value of total bilirubin in heart failure can be a simple and good indicator to know this tendency.
Journal of Cardiac Failure Vol. 11 No. 9 Suppl. 2005
EL5 Recent Topics in Dilated Cardiomyopathy TOHRU IZUMI Kitasato University, Sagamihara, Japan In field of dilated cardiomyopathy, we are now standing on a new paradigm. Historically, beta blocker therapy has clearly altered the fate of the patient with this disease. The patients with dilated cardiomyopathy, who are well responsive to this agent, are very well protected against remission. Most of them would be able to complete their lives without any difficulties if they would not stop taking it. In contrast, for patients who scarcely react to it, the prognosis is very poor. Their fate is very similar to patients of the past. From such a point of view, dilated cardiomyopathy refractory to beta blocker is an important issue in clinical medicine. How to make a proper diagnosis of chronic myocarditis, that is inflammatory cardiomyopathy, is now necessary. Cardiac imaging using magnetic resonance is a hopeful and strong answer concerning this issue. A combined approach of T2-weighted imaging and gadolinium enhancement provides us with the devices which have a high diagnostic value in the disease. Even if patients are positive in resonance imaging, endomyocardial biopsies are required to establish the final diagnosis. For patients with inflammatory cardiomyopathy, who are refractory to conventional therapy including beta-blockers, immuno-modulators are applied. As a result, half of them are responsive to this therapy. Out of 90%, autoantibodies against the heart are detected. Meanwhile, in 85% of the other not-responsive patients, virus genomes can be found. It will be assumed that if autoimmune myocarditis and cardiomyopathy could be really diagnosed, such immuno-modulators would be working well. Beside, as an experimental lesson, it has already been revealed that autoimmune myocarditis and cardiomyopathy might be worsened by beta blocker therapy. To differentiate the autoimmune disease and consider beta blocker use, magnetic resonance imaging can be very helpful. In dilated cardiomyopathy with advanced heart failure, the main concern has been focused on the LV function but not on RV function. This tendency that RV function has only a limited contribution to the assessment of this disease must be stopped. The RV dysfunction has been well known to be a powerful predictor of reduced exercise capacity and survival. Especially, despite better therapy, the prognosis of patients who show high pulmonary artery pressure and low RV ejection fraction is limited. Accordingly, the serum value of total bilirubin in heart failure can be a simple and good indicator to know this tendency.