Clinical Management and Prognosis in Dilated Cardiomyopathy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 June 2021) | Viewed by 4999

Special Issue Editor


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Guest Editor
Cardiovascular Division, University of Bari, 70123 Bari, Italy
Interests: cardiomyopathy; prognosis; echocardiography; systolic and diastolic cardiac function; long term outcome; cardiac transplantation; heart failure
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Special Issue Information

Dear Colleagues,

Dilated cardiomyopathy is unfortunately a problem on the rise. It is extremely important to be able to rely on very solid prognostication parameters in order to take the right therapeutic decision, as well as to follow up the effect of some interventions. These prognostic validated parameters (such as left ventricular ejection fraction etc.) can have very practical applications in the clinical arena. Needless to say, the more quantitative and easy to obtain the better. These parameters need to be validated not only in the short-mid term but also in the long term. And they could be of assistance in understanding the effect of some interventions (pharmacological or device-based): if such parameters improve we can see that the natural history of that patient can possibly be modified by such interventions. Otherwise, the absence of modifications of such prognostic indices after appropriate intervention should induce us to conclude that transplantation may be the only possible alternative.

A multiparametric approach to prognosis is important, so not only cardiac specific parameters could help in prognostication but also other parameters; for example, renal function parameters could be useful.

In addition, now there are a multitude of interventions (device implantation etc.) in heart failure patients with dilated cardiomyopathy which can have positive effects but also drawbacks: for example, infective endocarditis after device implantation. Therefore, a more critical approach to all these interventions is of the utmost importance. 

Prof. Dr. Carlo Caiati
Guest Editor

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Keywords

  • Cardiomyopathy
  • Prognosis
  • Echocardiography
  • Systolic and diastolic cardiac function
  • Long term outcome
  • Cardiac transplantation
  • Heart failure

Published Papers (2 papers)

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Research

19 pages, 2341 KiB  
Article
Predictors of Exercise Capacity in Dilated Cardiomyopathy with Focus on Pulmonary Venous Flow Recorded with Transesophageal Eco-Doppler
by Carlo Caiati, Adriana Argentiero, Cinzia Forleo, Stefano Favale and Mario Erminio Lepera
J. Clin. Med. 2021, 10(24), 5954; https://doi.org/10.3390/jcm10245954 - 18 Dec 2021
Cited by 3 | Viewed by 2095
Abstract
The aim of this study was to clarify the relative contribution of elevated left ventricle (LV) filling pressure (FP) estimated by pulmonary venous (PV) and mitral flow, transesophageal Doppler recording (TEE), and other extracardiac factors like obesity and renal insufficiency (KI) to exercise [...] Read more.
The aim of this study was to clarify the relative contribution of elevated left ventricle (LV) filling pressure (FP) estimated by pulmonary venous (PV) and mitral flow, transesophageal Doppler recording (TEE), and other extracardiac factors like obesity and renal insufficiency (KI) to exercise capacity (ExC) evaluated by cardiopulmonary exercise testing (CPX) in patients with dilated cardiomyopathy (DCM). During the CPX test, 119 patients (pts) with DCM underwent both peak VO2 consumption and then TEE with color-guided pulsed-wave Doppler recording of PVF and transmitral flow. In 78 patients (65%), peak VO2 was normal or mildly reduced (>14 mL/kg/min) (group 1) while it was markedly reduced (≤14 mL/kg/min) in 41 (group 2). In univariate analysis, systolic fraction (S Fract), a predictor of elevated pre-a LV diastolic FP, appeared to be the best diastolic parameter predicting a significantly reduced peak VO2. Logistic regression analysis identified five parameters yielding a unique, statistically significant contribution in predicting reduced ExC: creatinine clearance < 52 mL/min (odds ratio (OR) = 7.4, p = 0.007); female gender (OR = 7.1, p = 0.004); BMI > 28 (OR = 5.8, p = 0.029), age > 62 years (OR = 5.5, p = 0.03), S Fract < 59% (OR = 4.9, p = 0.02). Conclusion: KI was the strongest predictor of reduced ExC. The other modifiable factors were obesity and severe LV diastolic dysfunction expressed by blunted systolic venous flow. Contrarily, LV ejection fraction was not predictive, confirming other previous studies. This has important clinical implications. Full article
(This article belongs to the Special Issue Clinical Management and Prognosis in Dilated Cardiomyopathy)
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10 pages, 911 KiB  
Article
Effects of Sacubitril/Valsartan on the Right Ventricular Arterial Coupling in Patients with Heart Failure with Reduced Ejection Fraction
by Daniele Masarone, Vittoria Errigo, Enrico Melillo, Fabio Valente, Rita Gravino, Marina Verrengia, Ernesto Ammendola, Rossella Vastarella and Giuseppe Pacileo
J. Clin. Med. 2020, 9(10), 3159; https://doi.org/10.3390/jcm9103159 - 29 Sep 2020
Cited by 17 | Viewed by 2436
Abstract
Background: right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction [...] Read more.
Background: right ventricle-pulmonary artery (RV-PA) coupling assessed by measuring the tricuspid anular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio has been recently proposed as an early marker of right ventricular dysfunction in patients with heart failure with a reduced ejection fraction (HFrEF). Methods: As the effects of sacubitril/valsartan therapy on RV-PA coupling remain unknown, this study aimed to analyse the effect of this drug on TAPSE/PASP in patients with HFrEF. We retrospectively analysed all outpatients with HFrEF referred to our unit between October 2016 and July 2018. Results: At the 1-year follow-up, sacubitril/valsartan therapy was associated with a significant improvement in TAPSE (18.26 ± 3.7 vs. 19.6 ± 4.2 mm, p < 0.01), PASP (38.3 ± 15.7 vs. 33.7 ± 13.6, p < 0.05), and RV-PA coupling (0.57 ± 0.25 vs. 0.68 ± 0.30 p < 0.01). These improvements persisted at the 2-year follow-up. In the multivariable analysis, the improvement in the RV-PA coupling was independent of the left ventricular remodelling. Conclusions: in patients with HFrEF, sacubitril/valsartan improved the RV-PA coupling; however, further trials are necessary to evaluate the role of sacubitril/valsartan in the treatment of right ventricle (RV) dysfunction either associated or not associated with left ventricular dysfunction. Full article
(This article belongs to the Special Issue Clinical Management and Prognosis in Dilated Cardiomyopathy)
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