[Beneficial long-term effects of diltiazem on the course of dilated cardiomyopathy]
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H R Figulla1, J von Rechenberg, V Wiegand
1Medizinische Universitätskliniken, Abteilung für Kardiologie und Pulmonologie, Göttingen.
Insights
Adding diltiazem to conventional therapy significantly improved survival rates and cardiac function in patients with dilated cardiomyopathy. This treatment reduced mortality and enhanced hemodynamics, offering a promising therapeutic option for this condition.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Chronic catecholamine stimulation can negatively impact hemodynamics and prognosis in dilated cardiomyopathy.
- Myocellular calcium accumulation and microcirculatory disorders are implicated as potential causes.
Purpose:
- To investigate the effects of the calcium antagonist diltiazem as an adjunctive therapy in patients with dilated cardiomyopathy.
Summary:
- A prospective study involving 22 patients with dilated cardiomyopathy receiving diltiazem alongside conventional therapy (digitalis, diuretics, vasodilators).
- Compared to 25 historical controls on conventional therapy alone, the diltiazem group showed a significantly higher survival rate (p < 0.001).
- Left ventricular ejection fraction improved from 0.34 to 0.44 (p < 0.001), and New York Heart Association classification significantly improved in the diltiazem group.
Impact:
- Adjunctive diltiazem treatment demonstrates beneficial effects on mortality, hemodynamics, and symptoms in dilated cardiomyopathy.
- Suggests diltiazem as a valuable addition to standard treatment protocols for improving patient outcomes.
Abstract:
There is increasing evidence that chronic enhanced exogenic or endogenic catecholamine stimulation in patients with dilated cardiomyopathy may worsen hemodynamics and prognosis. The cause of this may lie in myocellular calcium accumulation and microcirculatory disorders. In a prospective study the calcium antagonist diltiazem was given to 22 patients with dilated cardiomyopathy (60-90 mg t.i.d.) in addition to conventional therapy of digitalis, diuretics, and vasodilators. Twenty-five patients received the conventional therapy and served as historical controls. Eight additional patients who were not originally included in the 25 controls changed over from conventional therapy to adjunctive diltiazem treatment. The patient groups compared were similar in all hemodynamic and anamnestic features. Further, only patients with reduced myofibril volume fraction in the myocardial biopsy were included in the trial, since hemodynamic deterioration could be expected in them. The mean survival rate was 29 months in the controls, while within a mean of 15.4 months no patient died in the diltiazem group (p less than 0.001). Mean left ventricular ejection fraction increased from 0.34 to 0.44 (p less than 0.001) and the New York Heart Association classification was significantly improved in the diltiazem group and during the diltiazem period in the crossovers, but deteriorated in the controls. Therefore, the results suggest that adjunctive diltiazem treatment in dilated cardiomyopathy has beneficial effects on letality, hemodynamics, and symptoms.