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Beneficial effects of long-term diltiazem treatment in dilated cardiomyopathy
H R Figulla1, J V Rechenberg, V Wiegand
1Department of Internal Medicine, University Hospital, University of Göttingen, West Germany.
Insights
Adjunctive diltiazem treatment significantly improved survival and cardiac function in patients with dilated cardiomyopathy. This calcium channel blocker demonstrated beneficial effects on mortality, hemodynamics, and symptoms in the study group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Chronic catecholamine stimulation may worsen dilated cardiomyopathy prognosis due to calcium overload and microcirculatory issues.
- Myocellular calcium accumulation and microcirculatory disorders are potential causes of deterioration in dilated cardiomyopathy.
Purpose of the Study:
- To evaluate the effects of adjunctive diltiazem treatment on mortality, hemodynamics, and symptoms in patients with dilated cardiomyopathy.
Main Methods:
- A prospective study involving 22 patients with dilated cardiomyopathy receiving diltiazem plus conventional therapy.
- A control group of 25 patients received conventional therapy; 8 patients later received diltiazem (crossover).
- Patients with reduced myofibrillar volume fraction on myocardial biopsy were selected.
Main Results:
- No deaths occurred in the diltiazem group over a mean 15.4-month follow-up, versus 29 months in the control group (p<0.001).
- Left ventricular ejection fraction increased from 0.34 to 0.44 (p<0.001) in the diltiazem group.
- New York Heart Association functional class improved with diltiazem and deteriorated in controls.
Conclusions:
- Adjunctive diltiazem treatment shows beneficial effects on mortality, hemodynamics, and symptoms in dilated cardiomyopathy.
- Diltiazem may counteract the negative effects of catecholamine stimulation in dilated cardiomyopathy.
Abstract:
There is increasing evidence that chronic enhanced exogenous or endogenous catecholamine stimulation in patients with dilated cardiomyopathy may worsen hemodynamic status and prognosis. The cause of this deterioration may lie in myocellular calcium accumulation and microcirculatory disorders. In a prospective study, the calcium channel antagonist diltiazem was given to 22 patients with dilated cardiomyopathy (60 to 90 mg three times daily) 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 this control group received adjunctive diltiazem treatment after initially receiving conventional therapy alone. The three patient groups were similar in all hemodynamic and anamnestic features. Only patients with reduced myofibrillar volume fraction on myocardial biopsy were included in the trial, because they could be expected to show hemodynamic deterioration. The mean survival time was 29 months in the control group, whereas no patient in the diltiazem group died over a mean follow-up period of 15.4 months (p less than 0.001). Mean left ventricular ejection fraction increased from 0.34 to 0.44 (p less than 0.001) and New York Heart Association functional class improved significantly in the diltiazem group and during the diltiazem period in the crossover patients, but deteriorated in the control group. The results suggest that adjunctive diltiazem treatment in dilated cardiomyopathy has beneficial effects on mortality, hemodynamics and symptoms.